Page 69 - JSOM Fall 2020

Tactical Combat Casualty Care in Operation Freedom’s Sentinel

Anant Shukla, MD FS *; Christian Perez, EMT ;
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Benjamin Hoemann, MDiv ; Martin Keasal, EMT 4

ABSTRACT
Over the course of nearly 19 years of conflict, Tactical Com- to be completed during the holiday season just before the de-
bat Casualty Care (TCCC) guidelines and their implementa- ployment. The classes were organized based on the main body
tion have evolved to incorporate the latest advances in trauma departure schedules to prioritize those first heading to Afghan-
research, casualty care, and transport, playing a large role in istan. Even with competing family obligations and operational
generating the lowest incidence of preventable deaths in the requirements, we still trained over 30% of our task force prior
history of modern warfare. During the conflicts in Afghan- to being boots on the ground.
istan and Iraq, the adoption and implementation of TCCC
principles by conventional forces have been extrapolated to We were deployed to a forward operating base (FOB) in south-
have been responsible for saving the lives of more than 1,000 eastern Afghanistan, and during our time we received the
US Servicemembers. As the intensity and nature of the military highest number of indirect fire (IDF) attacks since the creation
conflicts in Afghanistan and Iraq change, and a growing po- of the FOB in 2014, making the TCCC instruction crucial for
tential for a near peer conflict rises, it remains important that each Servicemember. When we arrived at our FOB, our team
the lessons of TCCC continue to be instilled in our formations made TCCC training a priority to both the organic and non-
in garrison, before deployment, and while in theater. This arti- organic personnel in our task force and focused on simplifying
cle reviews the use of TCCC principles by an assault helicopter the key tasks of preventing prehospital death in addressing
battalion, in combination with a variety of other factors, in the hemorrhage, tension pneumothorax, and airway obstruction.
successful management of a mass casualty event during Opera- Specifically, we focused on hemorrhage control with the proper
tion Freedom’s Sentinel 2019 in Afghanistan. application of the Combat Application Tourniquet, junctional
tourniquets, along with using hemostatic and pressure dress-
Keywords: Operation Freedom’s Sentinel; TCCC; lessons ings. In addition, we taught Servicemembers to perform needle
learned decompressions, apply chest seals, and perform certain airway
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maneuvers. Tarpey recounted a similar focus of instruction
geared toward addressing immediate life-threatening injuries
during his time as the battalion surgeon for an infantry unit
Introduction during the initial onset of Operation Iraqi Freedom in 2003.
In November 2018, a few months before Task Force Apoca-
lypse, 3-501 Assault Helicopter Battalion, 1st Combat Aviation Further, we performed many FOB-wide rehearsals, which al-
Brigade, 1st Armored Division, prepared to deploy to Afghan- lowed both medical and nonmedical personnel to refine their
istan in early 2019, members of the medical team and chaplain skills and understand their roles if a casualty event were to
corps completed their respective combat medical and ministe- occur, especially a mass casualty (MASCAL) event. The pro-
rial courses in San Antonio, Texas. In addition, the medical cess to get to that point took a very diplomatic approach to
team needed to fulfill the US Central Command TCCC training navigate the interests of each party on the FOB. To accomplish
directive and pass off the most applicable portions of the team’s this, SSG Keasal and CPT Shukla, within days of their arrival
collective TCCC knowledge to the rest of the unit on a very to the FOB, introduced themselves to the FOB commander,
limited timeline. CPT Shukla had just arrived to the unit in No- security force assistance detachment, contractor liaisons, and
vember 2018, and with the many changes to the deployment interpreters and made themselves and the Role 1 available for
roster, there unfortunately had not been a strong emphasis on any of their team’s medical needs on a 24/7 basis. The Role
getting TCCC completed until right before the holidays. 1 provided basic primary care and stabilization for trauma,
whereas the Role 2, about 2 miles on the other side of the
We worked with our battalion operations section (“S3 shop”) FOB, had blood, radiography, and surgical capabilities. This
to push out a TCCC-Combat Lifesaver training calendar and outreach initiative cut through a lot of red tape and allowed
relied on our paramedics from our medical evacuation unit everyone on the FOB to have instant access to high-quality
to help teach the class. Unfortunately, we had not been made medical care instead of having to fly to another FOB or base
aware of the many resources from the Joint Trauma System to see their organic healthcare provider. Building positive re-
and the Defense Health Agency’s (DHA) Deployed Medi- lationships early with every partner on the FOB allowed the
cine starter kit, which would have been very helpful in the Task Force Apocalypse medical team to have a seat at the table
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instruction. Understandably, the timing of the classes fell in to begin conversations about medical integration and obtain
competition among the multitude of other tasks that needed support for everything that occurred on the FOB.
*Correspondence to anant.shukla.mil@mail.mil
1 CPT Shukla, SGT Perez, CPT Hoemann and SSG Keasal are affiliated with the 3-501 Assault Helicopter Battalion, 1st Combat Aviation
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Brigade, 1st Armored Division, Ft Bliss TX.
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