Page 26 - JSOM Summer 2022

As noted previously, the MH-60S helicopters used to transport on the 1 August 2018 “TCCC for Medical Personnel” curricu-
the casualties to the LHA are not dedicated medical evacua- lum in addition to their civilian Paramedic training. The 2018
tion aircraft (they perform other missions as well) and have TCCC curriculum has now been replaced by the newly ap-
no medical equipment as part of their basic configuration. The proved Tier 3 (Combat Medic/Corpsman) TCCC curriculum.
SAR Medical Technician or other medical personnel would This curriculum is posted on the Deployed Medicine website
need to bring any needed medical equipment. at: https://deployedmedicine.com/market/299
The Tier 3 TCCC course should be used for all DoD corpsmen
TCCC Items Currently in the AMAL for Destroyers and medics below the paramedic level going forward.
• Ketamine
• Lactated Ringer’s The junior corpsmen should all have had EMT-Basic training
• Cricothyroidotomy set as part of their initial medical training, supplemented by the 1
• Oxygen as noted above August 2018 “TCCC for Medical Personnel” training course.
• Pulse oximeters (approximately 6) Corpsmen should take the newly approved Tier 3 TCCC train-
ing course when feasible.
NOT in the AMAL for this Class of Surface Combatant The Navy plans to have all SAR Medical Technicians trained
• TXA – only a single 1g dose is currently in the AMAL – this to the paramedic level, but this goal has not yet been accom-
is not enough for the three casualties who each require a 2g plished. All SAR Medical Technicians will have had EMT-
dose or even a single dose as recommended in the current Basic training as part of their initial medical training. This
TCCC Guidelines. basic medic training should have been supplemented by the 1
• OTFC (although injectable fentanyl [50mcg per mL, 5mL August 2018 “TCCC for Medical Personnel” training course.
amps] is on the list) Going forward, SMTs should take the newly approved Tier
• HPMK or other hypothermia prevention equipment (re- 3 TCCC training course when feasible and then the Tier 4
ported to be in the AMAL, but not found) TCCC course (Paramedics and Providers) when that becomes
• Pelvic binding devices available - if they are trained to the Paramedic level.
• Ertapenem for Casualties 1, 6, 7, and 8.
• One-way valves for chest tubes The Joint Consensus Statement from the Joint Trauma System,
• Hypertonic saline the Defense Committee on Trauma and the Armed Services
Blood program calls for all prehospital medical personnel in
TCCC Equipment Needed but Missing – Should Be the military to be trained to draw and infuse whole blood.31
Brought Over From the LHA to the Casualty Ship on the This has not yet been accomplished in the surface fleet.
First Evacuation Aircraft Also crucial to success in caring for trauma patients is – expe-
• Fresh Group O Whole Blood for Casualty 3 and Casualty 1 rience in caring for trauma patients. The training for military
• TXA for casualties 1, 3, and 4 – if not already on board combat medical personnel should include intermittent clinical
• Thawed plasma for the two burn casualties (#2 and #5) – if periods during which they will have the opportunity to help
directed by the surgeon on the LHA or the EM physician care for trauma victims.
from the STP
• OTFC for analgesia Casualty Disposition Beyond the Casualty
• Pelvic binding device Receiving Treatment Ship
• Blood administration sets As noted in the discussion of Casualty 6, these decisions would
• Intubation equipment and rapid sequence intubation not be made by the IDC on the casualty ship but would be
medications made by the CATF Surgeon and the Medical Regulating Con-
• Blood warmers trol Officer in coordination with the medical staffs at US Cen-
• Portable cardiac monitors tral Command, the Navy Central Command, and the US Fifth
• Ertapenem for Casualties 1, 6, 7, and 8. Fleet.
• Zoll ventilators as needed – with 10-hour batteries – can be
obtained from the LHA or the STP The following comments were contributed by CAPT Jeff
• One-way valves for chest tubes Timby, the current US Central Command Surgeon:
• Point-of-care ultrasound “There is obviously much more to the decision than
• 3% or 5% hypertonic saline
nautical miles to travel. We coordinate all of our pa-
tient movements with the Theater Patients Movements
Corpsman TCCC Training Requirement Center (TPMRC) and the US Military
Department of Defense Instruction 1322.24 requires that all Transportation Command (TRANSCOM) to ensure
US military personnel be trained in TCCC at the appropri- the proper care transitions are addressed. For example,
ate level for their participation in prehospital combat casualty Duqum, Oman is our typical evacuation site for In-
care. 8,9
ternational SOS (ISOS)-related care out of the Gulf of
The IDC and the junior corpsmen on the casualty ship all are Oman. Host Nation medical support is also a big part
required to have TCCC training at the Tier 3 (Basic Combat of our overall medical plan. Also, there is an open For-
Medic and Corpsman) level. eign Military Sales (FMS) case support for US military
support to the United Arab Emirates Trauma Burn and
The IDCs on the destroyer should be trained to the Tier 4 Rehabilitation Medicine (TBRM) facility to develop an
(Combat Paramedic and Provider) level, but this curriculum American College of Surgeons-verified Level I trauma
has not yet been completed and approved by the Joint Trauma center in Dubai at which we have permanent and,
Education and Training Branch of the Joint Trauma System. coming soon, rotational medical personnel. I would be
Currently, fleet IDCs should have had TCCC training based

24 | JSOM Volume 22, Edition 2 / Summer 2022