Page 101 - JSOM Summer 2020

Significant Deviations From TCCC Guidelines and • Other Observations:
Principles Noted in the Course Messaging o All four training sites taught the TCCC-recommended
• Harmful or Potentially Harmful Messaging Not in the method for resuscitation from hemorrhagic shock –
JTS Curriculum: the prehospital use of whole blood to avoid iatrogenic
o One instructor was discussing eye injuries and stated coagulopathy and to increase the bleeding casual-
that one could take a small needle and syringe and ty’s oxygen-carrying capability. None of the courses,
aspirate fluid from the anterior chamber of the eye however, had the students perform autologous blood
if an intraocular infection was suspected, thereby re- transfusions. One course had planned to do so, but
ducing the pressure inside the eye. (1 course) ran out of time and did not get to that training session.
o One instructor was discussing open-globe eye inju- o 20 of 184 (10.9%) TCCC-MP students had previ-
ries and stated that antibiotic gel should be placed on ously administered blood products in a deployed
the eye prior to shielding the eye. (1 course) environment.
o There was a commercial bias towards certain ven- o There was excellent hands-on instruction and skills
dors selling products that are not recommended by stations in all four courses.
the CoTCCC, to include TCCC cards, tourniquets, o Instructors provided the appropriate emphasis that
and other equipment items. (All four courses) you have to train for TCCC just as you would for
o Some courses are training students to use nonvented other aspects of combat with command attention,
chest seals vs the CoTCCC-recommended vented frequent repetition, expert oversight, and regular in-
chest seals because of concern that the vent in the corporation of simulated casualties into unit battle
chest seal might become obstructed with clotted drills.
blood and thus rendered nonfunctional and that this o The TCCC-MP courses appraised included all lev-
failure might be missed by the treating combat med- els of medical personnel, from basic combat medics/
ical personnel and cause an unrecognized tension corpsmen to deploying physicians.
pneumothorax. (three courses) o Most of the TCCC instructors had had combat med-
o Instructors did not know that ChitoGauze will not ical experience.
cause allergic reactions in individuals who are allergic o Instructors at the four training sites emphasized the
to shellfish when asked that question by students – need to be tactically aware at all times. Treatment
despite the fact that this fact is clearly stated in both is conducted with full realization that the tactical
the TCCC-MP curriculum and the product informa- environment may change quickly and require that
tion. (All four courses) the casualty be moved to a safer location or that the
o The TCCC-recommended electronic TCCC After treating medic stop treating the casualty and engage
Action Report was not trained. Instructors in general the enemy.
did not seem to be familiar with this care documen- o Many medics at all four courses were unfamiliar with
tation tool, despite the fact that it is in the JTS- the JTS Thursday morning trauma teleconferences.
approved TCCC curriculum. (All four courses) This is the single best source of real-time feedback
• Helpful or Potentially Helpful Messaging Not in the JTS regarding the TCCC interventions being used by the
Curriculum: US military at present.
o C-A-T Generation 7 tourniquet – instructors trained o Most instructors and most students at all four train-
the students to tape the trail end of the encircling band ing sites did not have a copy of the 9-line evacuation
after application since this device has been noted to request format in their aid bags.
come loose when applied to the leg and the casualty o Many of the instructors lacked comprehensive knowl-
subsequently moved. This problem has not to the au- edge about the TCCC topics that they taught and
thors’ knowledge been noted in any published case were not able to answer student questions about the
reports or case series on the C-A-T Generation 7 tour- material. Instructors should be experts on all aspects
niquet. This item was added as an agenda item for the of TCCC.
September 2019 CoTCCC meeting. (All four courses)
o Conflicting guidance on tranexamic acid (TXA) ad- Time Required to Conduct TCCC-MP Course Training
ministration – many TCCC instructors tell the stu- Table 3 shows the time that each of the appraised courses
dents to administer TXA via slow IV push rather spent in presenting the slides and videos as well as the time
than with a 10-minute infusion. A 10-minute in- spent on the skills sheets for each module.
fusion technique for TXA administration was the
method used in the large CRASH-2 study. The Discussion
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concern about administering TXA slow IV push is
that it might cause hypotension and/or seizures. Ad- This initial series of course appraisals represents the first at-
verse outcomes from slow IV push administration have tempt to observe and appraise TCCC training courses in a
not been reported in combat casualties to date, how- standardized, systematic manner. The results are concerning
ever, despite this technique being used in some units in in that TCCC-MP was not being trained to the JTS-recom-
both the US and UK militaries. (three courses) mended standard in any of the four locations appraised.
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o There were a number of excellent videos of ac-
tual TCCC interventions being performed that are Omitted or Misrepresented Material
not part of the TCCC-MP curriculum. These vid-
eos should be forwarded to CoTCCC staff and the Incorrect Messaging
JTET for consideration as potential additions to the The JTS conducts an ongoing combat casualty care process
TCCC-MP curriculum. (three courses) improvement effort that focuses on adverse casualty outcomes

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