Page 132 - JSOM Spring 2023

Where There’s a War, There’s a Way

A Brief Report on Tactical Combat Casualty Care Training
in a Multinational Environment

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Kaydn Conyers ; Aaron B. Gillies, BS ; Charles Sibley, MD ; Carl McMullen, MD ;
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Michael Remley, NREMT ; Scott Wence, MA ; Jennifer M. Gurney, MD, FACS *
ABSTRACT
Background: With most combat deaths occurring in prehos- rightly focused on improving the medical skills of the opera-
pital settings, the US Armed Forces focuses on life- threatening tional force through the adoption of TCCC in an effort to re-
conditions at or near the point of injury. Tactical Combat duce preventable deaths. TCCC guidelines are evidence-based,
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Casualty Care (TCCC) guidelines are required for all US Ser- best practice prehospital trauma care principles customized
vicemembers. Multinational militaries lack this requirement, for use on the battlefield. The implementation of the TCCC
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and international partner forces often have limited prehospital concepts helps to ensure quality medical care (e.g., hemorrhage
medical training. Methods: From November 2019 to March control and airway management) as close to the point of in-
2020, military members assigned to the Role 2E at the Ha- jury as possible. Without question, TCCC has saved lives on the
mid Kazai International Airport (HKIA) North Atlantic Treaty battlefield. Although the Department of Defense (DoD) has re-
Organization (NATO) base conducted multinational TCCC quired all Servicemembers to receive this training, the adoption,
training. The standardized Joint Trauma System (JTS) TCCC training itself, and its implementation have room for improve-
curriculum consisted of two-day classroom instruction and sit- ment. 2–11 However, as NATO does not require TCCC training,
uational training exercises. Competency was assessed through many coalition partners do not possess the requisite prehospital
verbalized and demonstrated knowledge. After Action Re- skills outlined in TCCC. This often-overlooked aspect of our
views (AAR) were completed. Results: Twelve multinational international partner forces’ capabilities increases the risk of po-
TCCC training courses trained 590 military Servicemembers tential preventable deaths.
and civilians from 10 countries, ranging from 16 to 62 partic-
ipants (avg class size = 35). Portugal and Turkey represented Although it is unrealistic to require all partner militaries to
the two largest participating nations with 219 and 133, respec- adopt TCCC as a requirement, our close partnerships over the
tively. Student feedback determined optimal group ratios for last 20 years of conflict have provided ample opportunities for
instruction. AARs were reviewed to categorize best practices. multinational dissemination of best practices, thereby reducing
Conclusion: Multinational TCCC standardization will save the risk of preventable deaths. To share the lessons of one de-
lives. Most nations lack TCCC training requirements. Thus, liberate effort, this paper will describe the implementation and
providing opportunities for standardized training for HKIA experience of a multinational TCCC training program at a busy
residents helped established a multinational baseline of medi- NATO base in Afghanistan. Specifically, this paper will cover
cal interoperability. Utilizing this curriculum in multinational the importance of a TCCC training program and how the pro-
environments can replicate these results. International adop- gram was delivered to a multinational audience while exploring
tion of TCCC is dynamic and ongoing and should be promul- the associated opportunities, challenges, and lessons learned.
gated to reduce preventable deaths.
The US, NATO, and other partner militaries were engaged
Keywords: tactical combat casualty care; TCCC; training, in combat and peacekeeping operations in Afghanistan from
trauma; MASCAL; mass casualty; deployed 2001 to 2021. The NATO base at HKIA in Kabul was estab-
lished in 2005 and was the last NATO base to close at the
conclusion of US military operations in 2021. Housing over 35
nations, and as many as 6000 residents, HKIA had a NATO
Background
Role 2E (R2E) Military Treatment Facility (MTF) that was
With greater than 90% of combat deaths occurring in the pre- staffed by personnel from nine different countries, six of which
hospital setting over the last 20 years of conflict, the US military did not speak English as their primary language. The HKIA
*Correspondence to jennifer.m.gurney.mil@health.mil
The following are the affiliations during the time of this study:
1 SSG Kaydn Conyers and Aaron B. Gillies were affiliated with the 3rd Security Forces Assistance Brigade. Charles Sibley was a physician at the
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HKIA NATO Role 2E and is affiliated with the Brook Army Medical Center, Fort Sam Houston, TX. Carl McMullen was a physician at the
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HKIA NATO Role 2E and is currently affiliated with the Madigan Army Medical Center, Joint-Base Lewis-McCord, WA. Michael Remley was
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and remains affiliated with the Joint Trauma System and the Department of Defense Center for Excellence for Trauma. Scott Wence is affiliated
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with the Marine Corps War College. Dr Jennifer Gurney was the commander of the NATO Role 2E at the Hamid Kazai International Airport
(HKIA) and is currently affiliated with the US Army Institute of Surgical Research and the Joint Trauma System.
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