Page 11 - JSOM Summer 2022

Tactical Combat Casualty Care Maritime Scenario

Shipboard Missile Strike

CAPT (Ret) Frank Butler*; HMCM Todd Burkholder; HMC Michael Chernenko;

CAPT (Ret) James Chimiak; CDR James Chung; CAPT Miguel Cubano; COL Jennifer Gurney;

Lt Col Andrew Hall; COL (Ret) John B. Holcomb; CAPT Joseph Kotora; CAPT Mark Lenart;

LCDR Ann Long; HMC Wayne Papalski; CMSgt (Ret) Tom Rich; CAPT Mike Tripp;

Col Stacy Shackelford; CAPT Matt D. Tadlock; CAPT Jeffrey Timby; CAPT Brendon Drew
ABSTRACT
The types of injuries seen in combat action on a naval surface While the original TCCC paper was published in 1996 after
ship may be similar in many respects to the injuries seen in a 3-year joint research effort conducted by US Special Opera-
ground combat, and the principles of care for those injuries tions Command medical personnel and the Uniformed Services
remain in large part the same. However, some contradistinc- University, it required almost 20 years for it to be incorporated
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tions in the care of combat casualties on a ship at sea must into doctrine. TCCC was mandated as the standard for battle-
be highlighted, since this care may entail a number of unique field trauma care in the US military by Department of Defense
challenges and different wounding patterns. This paper pres- (DoD) Instruction 1322.24, which also mandated TCCC train-
ents a scenario in which a guided missile destroyer is struck by ing for all DoD personnel, both medical and non-medical. The
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a missile fired from an unmanned aerial vehicle operated by an Chief of Naval Operations in 2021 directed how TCCC train-
undetermined hostile entity. Despite the presence of casualties ing should be implemented for all Naval forces. 9
who require care, the primary focus of a naval vessel that has
just been damaged by hostile action is to prevent the ship from Although the TCCC Guidelines provide evidence-based,
sinking and to conserve the fighting force on board the ship combat-tested, best-practice prehospital trauma care recom-
to the greatest extent possible. The casualties in this scenario mendations for specific injuries that may occur in combat and
include sailors injured by both blast and burns, as well as a have been well-documented to reduce preventable deaths in
casualty with a non-fatal drowning episode. Several of the ca- combat casualties, they do not address how the care of the
sualties have also suffered the effects of a nearby underwater casualty may have to be modified to be appropriate for the
explosion while immersed. Challenges in the care of these ca- specific tactical setting in which the casualty may be sustained.
sualties include delays in evacuation, the logistics of obtaining From the inception of TCCC, the need to consider the spe-
whole blood for transfusion while at sea, and transporting the cific tactical setting in which casualties occur has been em-
casualties to the next higher level of care aboard a Casualty phasized as a key factor in determining the optimal care for
Receiving and Treatment Ship. As the National Defense Strat- those casualties while they are still in the prehospital combat
egy pivots to a focus on the potential for maritime combat, environment. Different tactical settings may necessitate mark-
the medical community must continue to maintain readiness edly different casualty response plans for the same injury or
by preparing for clinical scenarios that may be unique to mar- constellation of injuries. This aspect of tactical medicine was
itime warfare. addressed through a series of workshops directed at specific
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operational environments, but shipboard casualties were
not included in that early series of workshops. This paper will
Keywords: underwater blast; TCCC; Tactical Combat Casualty
Care; burns; whole blood; hemorrhage control; shipboard; present a maritime casualty scenario and discuss a proposed
maritime casualties; naval surface warfare casualty response plan for that scenario.
Background
A review of shipboard casualties that have occurred in the past
Introduction provides an excellent overview of this topic. This document
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Over the last 20 years, the benefit of using Tactical Combat can be used as a reference to plan and train for potential mar-
Casualty Care (TCCC) concepts to treat wounds sustained in itime casualty generating events.
combat have been demonstrated by the reports of thousands The unique challenges that may be encountered when caring
of lives saved among US casualties in Afghanistan and Iraq. for casualties at sea include:
1–6
*Correspondence to fkb064@yahoo.com
Author affiliations are given on page 28.

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