Page 14 - JSOM Summer 2020

EXCERPT Advanced Technical Applications for Combat Ca- 2004;4(1):40–51
sualty Care (ATACCC) came and went by for the second year
since 9/11–recall that it was during ATACCC that the attack Tactical Medicine Training for SEAL Mission Commanders
on America happened. There were great presentations – we Butler F
got feedback by medics with first-hand experience in OEF and Previously published Mil Med 2001;166(7):625–631.
OIF and we are more committed than ever to meet the needs ABSTRACT The Tactical Combat Casualty Care (TCCC)
of our medics/corpsmen/PJs out there leading the way. Several project initiated by Naval Special Warfare and continued by
important issues were brought up: the US Special Operations Command has developed a new set
1. There was much discussion on the hemostatic agents of combat trauma care guidelines that seek to combine good
deployed into the conflicts. It turns out that the Fibrin medical care with good small-unit tactics. The principles of
Dressing was not used and that speaks very highly for the care recommended in TCCC have gained increasing accep-
discipline of our medics in following the guidelines of the tance throughout the Department of Defense in the four years
FDA IND protocol–use only when all other interventions since their publication and increasing numbers of combat
have failed. The Chitosan dressings were used with gen- medical personnel and military physicians have been trained
eral success in most cases and we have no negative feed- in this concept. Since casualty scenarios in small-unit opera-
back though not many were used. Editor’s Note: Please see tions typically present tactical as well as medical problems,
R&D article on Fibrin Dressing recall. QuikClot was used however, it has become apparent that a customized version
by the USMC Corpsmen on several occasions and we are of this course suitable for small-unit mission commanders is
gathering more data. The concerns about heat generation, a necessary addition to the program. This paper describes the
tissue charring, pain on application, and other safety con- development of a course in Tactical Medicine for SEAL Mis-
cerns has not lifted the SOF policy to not use this–we need sion Commanders and its transition into use in the Naval Spe-
to have our safety concerns addressed first. Col Holcomb cial Warfare community.
and the folks in San Antonio will work it out in the lab and
then we will have answers. Bottom line– there are several 2004;4(3):27–34
products out there and we hope they all work and are safe.
If you have personal experience with any of the products, Special Forces Battalion Aid Station in Support of a Direct
please send it our way for the data is very important. Action Task Force Fisk B
2. We reviewed the use of tourniquets and we were partic- ABSTRACT A Special Forces battalion aid station (BAS) ex-
ularly interested in the performance of the “one-handed” ecutes a wide range of medically related missions during de-
tourniquet invented by one of our soldiers and fielded ployment. However, this does not typically include attachment
quickly. Generally speaking it worked well on upper ex- to a small-unit direct action team. The BAS for Forward Oper-
tremity wounds but was less successful when applied to the ating Base (designation censored) had an uncommon opportu-
thigh with lower extremity wounds–no big surprise when nity when it received such a mission during Operation IRAQI
you picture the size of the thighs on Rangers, etc. How- FREEDOM (OIF). This article discusses the planning involved
ever, under the leadership of Ranger Miller et al, his ratchet and the configuration used to accomplish this mission. Fur-
tourniquets are also worthy of being studied. The last day thermore, we discuss lessons learned during the execution of
of the meeting was a little disappointing–the panel that was these missions, with their relevance to current tactical combat
discussing tourniquets was advocating for the old “sticks casualty care guidelines.
and rags” and some of them were going home to look for
a stronger dowel! But that is our problem here at the HQ– 2004;4(4):9–10
the medics want a tourniquet that can be applied with one
hand (on the chance you only have one hand that is func- NAVSPECWARCOM Component Surgeon: CAPT Edward
tional or that the opposite hand is otherwise occupied) and Woods, said “Recently, with recommendations through the
it needs to be small in weight and cube and be made avail- Army Institute for Surgical Research, we were able to deter-
able to every Soldier, Sailor, Airman, and Marine in harm’s mine the best tourniquet for use based on laboratory evalu-
way. You have made that very clear–self-aid is the issue ation but the real test will be when the Operators return and
with tourniquets and those who must wait for the medic to tell us that it works.”
stop hemorrhage are at high risk of exsanguination. Worry
not, that is why we have a Biomedical Initiatives Steering 2004;4(4):34–37
Committee (BISC) and we are listening and will get you In-Flight Transfusion of Packed Red Blood Cells on a Combat
gear that meets YOUR requirements. Search and Rescue Mission: A Case Report from Operation
Enduring Freedom Place R, West B, Bentley R
2003;3(4):47–55 Previously published Mil Med 2004;169(3):181–183.
Tactical Combat Casualty Care – 2003 Giebner S ABSTRACT Injuries on the battlefield can occur far from
the nearest medical treatment facility. This is especially likely
ABSTRACT The original guidelines for Tactical Combat Ca-
sualty Care were published in 1996. In 2000, the USSOCOM for downed pilots and Special Operations personnel. Some of
Biomedical Initiatives Steering Committee convened the these injuries lead to significant blood loss requiring transfu-
Committee on Tactical Combat Casualty Care (CoTCCC) to sion. We present two cases of injured coalition force members
update the guidelines to reflect advances in pharmacology, during Operation Enduring Freedom that illustrate the poten-
technology, and tactics. The CoTCCC completed this work tial need for a transfusion capability at the site of injury to
in 2003. The new guidelines are introduced and presented in prevent death. Consideration should be given to augmenting
comparison to the original, with a brief discussion of the ratio- transfusion capabilities in military environments with predict-
nale behind the changes. ably long evacuation times.

12 | JSOM Volume 20, Edition 2 / Summer 2020