Page 132 - JSOM Spring 2021

of combat trauma in the tactical Special Warfare environment military forces, this protocol by itself is not adequate training
and make recommendations for changes as appropriate. The for the management of combat trauma in the tactical envi-
research approach used was to do a preliminary literature re- ronment. Since casualty scenarios in small-unit operations en-
view and establish an initial set of recommendations. The rec- tail tactical problems as well as medical ones, the appropriate
ommendations were then reviewed over a six-month period in management plan for a particular casualty must be developed
meetings with Special Operations corpsmen, medics, and phy- with an appreciation for the entire tactical situation at hand.
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sicians, and consensus opinions were developed. Draft copies This approach has been developed through a series of work-
of the paper were then sent out to approximately 30 subject shops carried out by SOF medical personnel in association
matter experts in the fields of emergency medicine, general with appropriate medical specialty groups such as the Under-
and trauma surgery, critical care medicine, anesthesiology, and sea and Hyperbaric Medical Society, the Wilderness Medical
cardiothoracic surgery. The paper was again revised to incor- Society, and the Special Operations Medical Association. 8–10
porate changes recommended by these reviewers and subse- The most recent of these workshops, which addressed the
quently published as a Supplement to Military Medicine. The Tactical Management of Urban Warfare Casualties in Special
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approach used was intended to ensure that the TCCC guide- Operations, noted that several of the casualty scenarios stud-
lines had as much input as possible from combat corpsmen ied from the Mogadishu action in 1993 had very important
and medics. tactical implications for the mission commanders. 10,11 The un-
conscious fast-rope fall victim in the first scenario resulted in
tccc trAnsItIon a decision by the mission commander to split the forces in his
Preliminary concept approval was first obtained from the ground convoy, detaching three of the twelve vehicles to take
Commander of the Naval Special Warfare Command. The next the casualty back to base immediately, leaving the remaining
step in the process was to take it to the Bureau of Medicine and nine to extract the rest of the troops. The helicopter crash de-
Surgery (BUMED). Initial BUMED contact was with CAPT scribed in Scenario 2 resulted in the pilot’s body being trapped
Bob Hufstader, then Deputy Chief of the Medical Corps, who in the wreck. As several discrete elements from the target
proposed that the best way to approach BUMED evaluation building moved towards the crash site to assist, as described in
was to determine specifically which courses TCCC should be Scenarios 5 and 6, they suffered multiple casualties. The casu-
taught in and to seek out the individuals responsible for teach- alties eventually outnumbered those who were able to maneu-
ing that course. This was accomplished and, in March 1996, ver, forcing the elements to remain stationary and preventing
TCCC training was incorporated into the Undersea Medical them from consolidating their forces. When a rescue convoy
Officer (UMO) training course in Groton, Connecticut, which finally reached the embattled troops at the crash site, there was
is responsible for training the UMOs who support SEAL units. a delay of approximately three hours while the force worked
After this action had been taken, final approval of this con- feverishly to free the trapped body. Several hundred troops
cept was approved from the Commander of the Naval Special and over 25 vehicles were vulnerable to counterattack during
Warfare Command. In his letter of 9 April 1997, RADM Tom this period. These scenarios made it obvious to members of the
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Richards directed that the TCCC guidelines as outlined in ref- workshop panel that training only combat medics in tactical
erence two be used as the standard of care for the tactical man- medicine is not enough. If tactical medicine involves complex
agement of combat trauma in Naval Special Warfare. decisions about both tactics and medicine, then we must train
A six-hour TCCC course for SEAL corpsmen was devel- the tactical decisionmakers—the mission commanders—as
oped, approved by BUMED, and taught to all SEAL corpsmen well as combat medical personnel in this area. This paper is
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beginning in April of 1997. This course was designed to sup- a description of how that has been accomplished in the Naval
plement the extensive trauma training received by SEAL corps- Special Warfare community.
men at the Joint Special Operations Medical Training Center
(JSOMTC). The JSOMTC has now added the TCCC course the tActIcAl MedIcIne For
to its curriculum. The principles of TCCC as taught in this seAl MIssIon coMMAnders course
course have also been adopted at least in part by the USAF, The concept of medical training for Special Operations
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the US Army (personal communication, COL Richard Shipley, combat Operators is not new, but in the past, this training has
Commander of the US Army Academy of Health Sciences), the usually focused on skills rather than strategies. The Operators
Israeli Defense Force, the US Army Special Forces, and the were trained to start IVs, apply field dressings, and so forth.
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US Marine Corps. The TCCC course was taught at the Field This training is important, but needs to be supplemented by
Medical Service School at Camp Pendleton for the first time in a strategies approach to combat medicine. A Tactical Medi-
February 2000. cine for SEAL Mission Commanders Course was developed
One of the most important milestones in the transition to meet this need. The course is currently comprised of 5 main
process was the inclusion of the TCCC guidelines in the Pre- sections:
hospital Trauma Life Support Manual. The fourth edition of
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this manual, published in 1999, contains for the first time a a) A background of the Tactical Combat Casualty Care
chapter on military medicine. Preparation of this chapter was initiative;
coordinated by CAPT Greg Adkisson and COL Steve Yevich b) An explanation of the need to train mission commanders
of the Defense Medical Readiness Training Institute in San An- in this area;
tonio, Texas. The recommendations contained in the PHTLS c) A description of how people die in ground combat;
Manual carry the endorsement of the American College of d) The TCCC guidelines for Care Under Fire and Tactical
Surgeons Committee on Trauma and the National Association Field Care;
of EMTs. The TCCC guidelines are the only set of battlefield e) An introduction to scenario-based training and planning.
trauma guidelines ever to have received this dual endorsement
Although the TCCC protocol is gaining increasing accep- The background of the TCCC concept is presented as described
tance throughout the US Department of Defense and allied above. The remaining aspects of the course are outlined below.

128 | JSOM V olume 21, Edition 1 / Spring 2021
128 | JSOM Volume 21, Edition 1 / Spring 2021