Page 133 - JSOM Spring 2023

Figure 1: Nations and number of participants trained in TCCC at HKIA
over a four month period.
R2E MTF had an extended capability beyond a typical US FIGURE 1 Nations and number of participants trained in TCCC at
R2 with additional emergency, dental, and multinational pri- HKIA over a four month period.
mary care capabilities. The hospital was based on a US medi-
cal framework and was under US command until April 2020.
Following trauma training exercises conducted by the R2E
personnel, many gaps in overall trauma readiness, including
prehospital care and the HKIA mass casualty (MASCAL) plan,
were identified. Given the ongoing threat at HKIA, the hospi-
tal leadership sought to increase the base’s medical-readiness
posture. One of these efforts was to organize a multinational
TCCC training program for international partner forces, con-
tractors, and civilians assigned to HKIA.

Methods
From November 2019 to March 2020, military members as-
signed to the R2E MTF at HKIA partnered with the 3rd Se- trauma systems, most nations still lack training for prehospi-
curity Forces Assistance Brigade (SFAB) to conduct base-wide tal care. Therefore, many NATO and non-NATO nations in
TCCC training. To ensure standardization for the multina- Afghanistan lacked prehospital training on TCCC concepts.
tional participants and due to the inherent language barriers, Given the multinational nature of global military operations
the course adhered to the readily available “Defense Health and the disparities of prehospital care/TCCC training across
Agency TCCC All Service Members Course.” Prior to each nations, ensuring a standard for prehospital care in multi-
course, approvals were required from each respective nation’s national environments will help save lives from traumatic
command element, the HKIA Commander, and HKIA’s Force injuries.
Protection elements.
Following HKIA’s 4-month TCCC training plan for the multi-
The cadre of instructors included a multinational represen- national and multilingual population, the lessons learned be-
tation of TCCC trained medical officers and enlisted service low are the most relevant:
members from the US, NATO, and other coalition nations. Li-
censed linguists were used in the standardized two-day course 1. Effectiveness: Since TCCC was not required for most mil-
that consisted of initial classroom instruction (Day 1) and a itaries on HKIA, the promulgation of TCCC concepts
field training exercise (Day 2). A 10:1 student-to-cadre mem- throughout the base was instrumental. The challenge of
ber ratio was used for Day 1, while a 5:1 ratio was used for effective implementation and promulgation without a
the Day 2 Care Under Fire and Tactical Field Care Exercise. validated requirement is often a substantial hurdle in the
Designed to emphasize team dynamics, tactical awareness, and military. Getting initial buy-in from leaders and residents
TCCC medical tasks, participants wore combat gear during of HKIA was a challenge, but res ipsa loquitur, ‘the thing
the Day 2 culminating exercise. If necessary, remedial training speaks for itself,’ as soldiers and civilians recognized the
and/or further instruction were conducted to ensure standards value and lifesaving nature of the techniques being taught.
were met. With experienced and passionate instructors from the R2E
and the 3rd SFAB, the TCCC course positively impacted
To continuously improve the course, an AAR was conducted HKIA’s culture and transcended into other aspects of pre-
after each instruction set and at the course conclusion; both the hospital care. Specifically, the enthusiasm generated from
cadre and participants evaluated aspects of the training that the TCCC course not only impacted funding and partic-
required additional reinforcement to improve subsequent iter- ipation, but more importantly, it resulted in better medi-
ations of the course. This feedback was rapidly implemented cal equipment prepositioned at Casualty Collection Points
and included such changes as: optimized instructor-to-student across the base and in better medical equipment taken in
ratios; course and translator scheduling; scenario modifica- vehicles on combat missions.
tion; increased hands-on training for tourniquets; simulation Adaptability was key to overall effectiveness to meet
realism; and cultural allowances. scheduling, cultural, and individual learning needs. Al-
though mainly qualitative in nature, the mindset of HKIA
Results evolved through the conduction of this course as it grad-
Over a 4-month period, a total of 12 courses were conducted ually enhanced relationships beyond the hospital between
for 590 military and civilian personnel (~10% of HKIA popu- disparate groups from various cultures. The significance of
lation) from 10 countries (Figure 1). Course sizes ranged from these relationships and the trust developed with partners
16 to 62, with a mean of 35 participants. Portugal and Turkey across the base cannot be understated, especially in an envi-
had sizeable troop numbers on HKIA because they provided ronment in which the teams are divided by workspaces and
Force Protection; they were the largest participating nations language. Having a common language for prehospital care
with 219 and 133 military members trained, respectively. broke down cultural barriers and improved HKIA’s overall
Cadre met the instructor-to-student ratios of 10:1 for Day 1 trauma readiness posture.
and 5:1 for Day 2. 2. Leadership: As is often the case, a leader’s priority becomes
a subordinate’s priority. Base and unit senior leadership
were paramount in optimizing the TCCC course as they en-
Discussion
couraged attendance; adjusted work schedules to facilitate
TCCC saves lives in the prehospital environment. Although attendance; and provided linguist, logistics, and financial
the US has adopted TCCC in both their military and civilian support (medical supplies are not free). This prioritization

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