Page 70 - JSOM Fall 2020

We knew it would be a matter of time before the enemy got and knowing to obtain a litter from a bunker. The premise of
lucky with the IDF attacks. When an enemy rocket hit a US effective instruction is really demonstrated in that none of the
contractor, causing a traumatic amputation, the liaison for the first responders had any medical or TCCC training prior to
contract company approached our team for TCCC equipment. what they had learned from our team. The most critically in-
We provided both training and equipment to more than 100 jured Servicemember suffered a 10cm laceration of his femoral
contractors in TCCC. artery and lost a considerable amount of blood. A large-scale
retrospective study by Howard et al found that in military
The liaison stated that he had asked for his company to pro- conflicts in Afghanistan and Iraq from 2001 to 2017, the use
vide TCCC training before sending its employees to the FOB of tourniquets, rapid casualty transport and blood transfu-
in light of the amount of violence in the area; however, his sions have been responsible for reducing the US mortality rate
requests fell on deaf ears. “No one ever listens until something by 44.2%. To that end, when the first responders placed tour-
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bad happens,” he told us ominously. niquets in the appropriate location and to the standard, they
saved that Servicemember’s life. Had we known about the De-
ployed Medicine Starter Kit provided by the DHA, our team
Overview of the Attack
would have spent less time preparing the materials for TCCC
In August 2019, an enemy rocket attack on the FOB injured instruction. Furthermore, it would have been more ideal had
dozens of US Servicemembers. Multiple tents erupted into the trainings been started earlier in garrison to prevent any
flames from the explosion; however, Servicemembers in the instructions from being rushed.
area sprang into action within seconds. Flames were extin-
guished with easily accessible fire extinguishers located in each Rehearsals/Education
tent, and TCCC-trained Servicemembers placed two high- The aviation and infantry medics on our team were young
and-tight tourniquets on a critically injured soldier. When and their experience in garrison was delegated to taking vitals
our team arrived within 2 minutes with the “Mobile Role 1,” and starting electronic medical record notes in the clinic. CPT
those same Servicemembers were preparing to move him to the Shukla and SSG Keasal hoped to recondition this mentality
vehicle. Once placed in the vehicle, CPT Shukla and another early in the deployment by having medics directly involved
medic continued to treat him during the 3-minute ride to the with patient care. The instruction started with the basics such
Role 2, placing hemostatic gauze, laying a ready-heat blanket, as taking a complete history, performing physical exams, and
attempting to get intravenous access, and applying direct pres- coming up with management plans. Soon a transition was seen
sure to keep him alive. After we handed off that Servicemem- and appreciated by the medics as they were more confident
ber to the surgeons, we returned to the Role 1 battalion aid and competent and felt more empowered to complete tasks
station to manage the MASCAL event. and the mission with minimal guidance. When individuals are
engaged and have ownership, they will accomplish tasks and
innovate solutions for the betterment of the organization and
Casualties
the mission. Then the education moved into trauma manage-
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Our team would ultimately treat about three dozen Service- ment, which was something they had already practiced when
members whose injuries ranged from shrapnel lacerations, teaching the TCCC courses in garrison. When we had our
traumatic brain injuries, and smoke inhalation. Triage and MASCAL event, having more medical providers comfortable
care had already started under SSG Keasal’s guidance while with laying hands on patients served as a force multiplier.
the most severely injured casualty, as described earlier, was
transported. When CPT Shukla returned to the Role 1, SSG Medical Integration
Keasal signed out all the patients to him. Each patient was During that initial 90 days of our deployment, we conducted
evaluated, their note was documented on a Department of De- FOB-wide rehearsals integrating all providers, both medical
fense Standard Form 600, organized into their own personal and ministerial, and our administrative personnel “S1” into
packet to ensure no loss of records, and their follow-up plan every battle drill. After each battle drill, we performed an af-
explained them. Then they were seen by our chaplain, if nec- ter-action review and made small adjustments to our plans
essary, to provide early pastoral and spiritual care. An admin- to ensure our readiness for any eventuality. We continued to
istrative representative, “S1,” in the aid station gave updates adjust our response and position our resources to be most
to our command team and relayed our situation up to higher effective. It has been well documented that under simulated
headquarters at Bagram Airfield. Our team frequently spoke combat situations, performance in applying tourniquets di-
with the Role 2 emergency medicine physician about our cau- minishes, hence frequent drills help decrease the skill attrition
salities and who may need additional care and who we could seen during real world events. By involving our chaplain,
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hold onto. Regardless, our management of this event brought CPT Hoemann, and S1 in all of our battle drills, we knew
organization to chaos. It provided compassionate and effective through trial and error where to place them so they would not
care to young individuals who had never experienced such a crowd the aid station during chaotic events. The S1 would be
traumatic event in their lives. The most important fact was able to account for casualties, answer phone calls, and pass
that no one died. up battle roster numbers or patient identification up the chain
of command, which freed up a medic to perform medical care.
This also gave the command better situational awareness of
Lessons Learned
the event and what information to push up to higher head-
TCCC Training quarters. CPT Hoemann would speak to a casualty when the
The successful completion of TCCC training for all US Ser- most critical portions of medical care were completed, and
vicemembers within 90 days of our arrival allowed the first if they were discharged from the Role 1, they were given a
responders on the scene, an Apache maintainer and a Chinook follow-up appointment the next day with him and with CPT
Avionics mechanic, to feel comfortable in applying tourniquets Shukla.

68 | JSOM Volume 20, Edition 3 / Fall 2020