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the American Medical Association, and from the most recent Trauma Life Support Manual, are specifically designed for use
“new” panel member, Vice Admiral Richard Carmona, Sur- on the battlefield and have the endorsement of the National
geon General of the United States. For those of you that may Registry of Emergency Medical Technicians and the American
not know it, VADM Carmona started out as a 91B4S, a Spe- College of Surgeons Committee on Trauma.
cial Forces Medical Sergeant, circa 1968.
2004;4(3):1–2
2003;3(4):47–55 FROM THE SURGEON Frank Butler, MD, CAPT, USN,
TACTICAL COMBAT CASUALTY CARE–2003 Stephen D. HQ USSOCOM Command Surgeon
Giebner, MD, MPH
EXCERPT: Tactical Combat Casualty Care Transition Ini-
ABSTRACT: The original guidelines for Tactical Combat Ca- tiative Both Special Operations medics and non-medical SOF
sualty Care were published in 1996. In 2000, the USSOCOM combatants may be required to provide care on the battle-
Biomedical Initiatives Steering Committee convened the field for their wounded teammates. Strategies for caring for
Committee on Tactical Combat Casualty Care (CoTCCC) to the wounded in this setting are often radically different than
update the guidelines to reflect advances in pharmacology, the care that would be rendered in the civilian setting because
technology, and tactics. The CoTCCC completed this work of the austere tactical environment and the need to consider
in 2003. The new guidelines are introduced and presented in factors related to the conduct of the unit’s mission. Guidelines
comparison to the original, with a brief discussion of the ratio- for Tactical Combat Casualty Care (TCCC) are developed on
nale behind the changes. an ongoing basis by a committee initiated by USSOCOM and
now sponsored by the Navy Bureau of Medicine and Surgery.
2004;4(1):40 Updated TCCC guidelines are published every three years in
Tactical Medicine Training for SEAL Mission Commanders the Prehospital Trauma Life Support Manual, which carries
Frank K. Butler, Jr, MD the endorsement of the American College of Surgeons and
the National Association of Emergency Medical Technicians
ABSTRACT: The Tactical Combat Casualty Care (TCCC) (EMTs).
project initiated by Naval Special Warfare and continued by
the US Special Operations Command has developed a new set These guidelines are now well-accepted and used widely
of combat trauma care guidelines that seek to combine good throughout the DoD, but transitioning new medical tech-
medical care with good small-unit tactics. The principles of niques and equipment expeditiously to SOF units deploying in
care recommended in TCCC have gained increasing accep- support of the Global War on Terrorism remains a challenge.
tance throughout the Department of Defense in the four years There are a number of items that must be accomplished in or-
since their publication and increasing numbers of combat der to meet this challenge. First, we must mitigate the inherent
medical personnel and military physicians have been trained delays associated with updating allowed equipment lists and
in this concept. Since casualty scenarios in small-unit opera- academic medical curricula to ensure that our warfighters go
tions typically present tactical as well as medical problems, forward into theater with state-of-the-art medical equipment
however, it has become apparent that a customized version and strategies. Secondly, there is a need to have a coordinated
of this course suitable for small-unit mission commanders is program to train all SOF combatants in the essential lifesaving
a necessary addition to the program. This paper describes the trauma care strategies outlined for non-medical combatants in
development of a course in Tactical Medicine for SEAL Mis- the PHTLS chapter on TCCC. Lastly, we need to systemati-
sion Commanders and its transition into use in the Naval Spe- cally gather input from SOF combat medics about unit casual-
cial Warfare community. ties suffered and how well the new techniques and equipment
worked in caring for these casualties.
2004;4(2):1–2 A POM 06 initiative to address these issues has been initi-
FROM THE SURGEON Frank Butler, MD, CAPT, USN, ated by the USSOCOM Surgeon’s office and was endorsed by
Command Surgeon, US Special Operations Command all four USSOCOM Component Surgeons during the POM
April 2004 process. The strong collective voice of the SOF medical com-
EXCERPT: The USSOCOM Surgeon’s office has helped co- munity resulted in this initiative being supported by the US-
ordinate the placement of medical planners on the staff of the SOCOM requirements process in the first draft of the POM.
theater Special Operations commanders, assisting those com- As an interim measure, the USSOCOM Biomedical Initiatives
mands with medical support for their operations. The Jour- Steering Committee is initiating a pilot program called the
nal of Special Operations Medicine continues to provide a TCCC Transition Initiative to be conducted by the US Army
central voice for the Special Operations medical community, Institute of Surgical Research (ISR). This research effort will
and the quality of this excellent publication continues to im- start examining ways to expedite the transition of new trauma
prove. USSOCOM took a leadership role in the development care strategies to our deploying SOF units.
and fielding of hemostatic dressings in the US military, early The USSOCOM Surgeon’s office in coordination with the
in the initial proof-of-concept studies at the Army Institute for Component Surgeons will identify SOF units that will be de-
Surgical Research and later, working with the Army Medical ploying in the near future. The deploying units will be con-
Research and Materiel Command to obtain funding to pro- tacted and commanders asked if they would like for their units
cure these lifesaving dressings for our warfighters. Last, Col to receive the updated Tactical Combat Casualty Care training
Hammer was a strong supporter of the USSOCOM/BUMED and equipment for both their medics and non-medical per-
combined effort to establish a standing Committee on Tacti- sonnel prior to the unit’s deployment into theater. Focusing
cal Combat Casualty Care (TCCC), which is now providing on units that will be deploying in the near future will ensure
updated guidelines in TCCC for our deploying combat med- that all deploying forces have the opportunity to be optimally
ical personnel. These guidelines, published in the Prehospital prepared to deal with battlefield trauma care during their

Then and Now: 20 Years In Publication | 13