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his is our final Then and Now series celebrating our
20 years in publication. As with the last three topics on TCCC ARTICLES, THEN
TWhole Blood, Tourniquets, and Prolonged Field Care,
we have provided either abstracts or excerpts from the first 2002;2(3):15
and the last 5 years of publication. We have provided you the RESEARCH & DEVELOPMENT
edition and title of TCCC-related articles for the 10 years in USSOCOM Biomedical Initiatives Steering Committee (BISC)
between. Robert Clayton

FY02 RESEARCH IS CURRENTLY UNDERWAY ON THE
TCCC Introduction FOLLOWING PROJECTS:
by CAPT (Ret) Frank Butler
EXCERPT: … 4. SOF Committee on Tactical Combat Casu-
TCCC is a set of evidence-based prehospital trauma care alty Care (TCCC)
guidelines that have been customized for use on the battle-
field. TCCC began as a project in the Naval Special Warfare 2002;2(4):1
Biomedical Research Program in 1992. ENLISTED CORNER Senior Enlisted Medical Advisor
(SEMA), MSG Michael A. Brochu.
In 1992, it became obvious that the greatest opportunity to
improve combat casualty care lay in the prehospital phase of EXCERPT: … where we stand at the publishing of this journal:
care, because that is where most combat fatalities occur. Al- 3. Tactical Combat Casualty Care Panel (TCCC): When the
most 90% of combat fatalities occur BEFORE the casualty OEF lessons learned was conducted the TCCC panel convened
gets to the care of a surgeon. If a combat casualty lives long in Pensacola, Florida. This panel will be one of the driving
enough to reach the care of a surgeon, the odds are over- forces to effect positive change to the SOF medical TTPs of the
whelming that he or she will survive. That means that the future. This panel will have two more meetings to discuss the
care he or she receives from the combat medic, corpsman, TTPs before any suggestions are made to any further change.
or PJ is the most important determinant of whether they live
or die. 2003;3(2):20
RESEARCH & DEVELOPMENT
The 3-year Tactical Combat Casualty Care research effort was Biomedical Research and Development Update Bob Clayton
a joint effort of the Special Operations medical community
and the Uniformed Services University. This relook at battle- EXCERPT: The USSOCOM Biomedical Initiatives Steering
field trauma care included strong input from combat medical Committee (BISC) conducted its quarterly meeting in March
personnel as well as from trauma surgeons and emergency 2003 to discuss projects and programs that support Special
medicine physicians. The recommendations were evidence Operations medical issues. One of the strong points of the
based—including requiring evidence for current practice at the BISC is the ability to rapidly address issues or requirements
time as well as for proposed changes to the standard of care. that come from the field. Recently the BISC funded two Com-
The primary metric used in evaluating possible recommenda- bat Casualty Care panels that were focused on issues that
tions was whether they could be shown to effectively reduce emerged from operations in Afghanistan. The Tactical Com-
preventable death. bat Casualty Care Panel (TCCCP) was formed to review the
Pre-Hospital Trauma Life Support protocols. The TCCCP
The TCCC paper was published in 1996 and contained an Panel was made up of both military and civilian medical per-
updated set of recommendations for battlefield trauma care sonnel who had extensive experience in far forward care and
in Special Operations, but trauma care concepts, as with most in emergency medicine. As a result of the TCCCP, the military
things in medicine, evolve over time. In 2001, the CoTCCC chapter of the PHTLS manual is being rewritten to highlight
was established as a combined effort of the U.S. Special Op- those protocols that are relevant to military operational med-
erations Command and the Navy Operational Medicine Insti- icine. This will provide the foundation for developing a scope
tute to keep TCCC current going forward. of practice that more realistically addresses the way SOF med-
ical personnel practice their skills. Like most programs that
TCCC is now the standard for battlefield trauma care, but it start in SOF, a transition path has been developed so that this
will ALWAYS be a work in progress. Functioning as one of the panel is now a DOD panel, which will be managed and funded
three committees of the Joint Trauma System’s Defense Com- by the Navy. Panel membership will remain as previously es-
mittee on Trauma, the CoTCCC will continue its efforts to tablished, so that the continuity and momentum will continue.
ensure that our country’s combat wounded have the very best There are still several steps to be taken to finish the protocol
battlefield trauma care possible. approval process, but much headway has been accomplished
with support coming from the Service Surgeons General, sev-
eral esteemed members of the American College of Surgeons,

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