Page 134 - JSOM Spring 2023

by senior leadership generated significant interest in the Conclusion
TCCC from various units base-wide. Each course con-
cluded with a closing ceremony and formal presentation Saving lives in a combat zone starts with point of injury care.
of individual certificates signifying successful completion. Although TCCC is embraced in the US military’s trauma sys-
Culturally, this recognition was important for many of the tem, other nations vary in their prehospital trauma training. In
participating nations and allowed leaders to recognize their any conflict or combat zone, it is a moral imperative that those
soldiers’ accomplishments, further fostering buy-in and en- with TCCC training assist others in learning these life-saving
thusiasm for TCCC. prehospital interventions. This is evident today in Ukraine, as
3. Creates a culture of commitment to casualty response: As initial reports suggest they lack prehospital care knowledge,
TCCC capabilities increased across HKIA, the training skills, and abilities and are therefore likely experiencing high
prompted and encouraged a base-wide culture of trauma rates of prehospital preventable deaths. To help mitigate this
focus and readiness, which helped to improve the other as- gap, the JTS and Committee on TCCC have placed the TCCC
pects of the casualty response system. The standardization Guidelines in Ukrainian on the JTS website to facilitate poten-
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and improvement of TCCC medical equipment at HKIA’s tial training opportunities.
Casualty Collection Points (in case of a base MASCAL) and
the enthusiasm to implement monthly base-wide MASCAL As we learned at HKIA, most militaries do not have a baseline
exercises were all notable requirement for TCCC training and most multinational soldiers
4. Implementation considerations: The challenges of instruct- had little to no training. However, we also learned that the stan-
ing a standardized course to a culturally-diverse population dardization and instruction of TCCC is feasible, well-received,
should be anticipated. and greatly beneficial. The delivery of TCCC to multinational
a. Gender considerations. Some of the nations deployed to partners not only provides a venue to build relationships across
HKIA limit interactions between males and females. It nations, but more importantly, it also shapes and standardizes
became quickly apparent that many participants were international prehospital casualty care language, treatment,
uncomfortable placing ‘high and tight’ tourniquets on and expectations. This training model demonstrates the prag-
members of the opposite gender. Pairing students by matism of training in an operational environment and can be
gender helped reduce distractions during the training. adopted in the humanitarian space as well, especially for hu-
b. Linguists. Language translation was crucial for effec- manitarian teams that are working in conflict zones.
tive teaching to non-English speakers, but the added
time required for translation must be considered when Ideally, TCCC training will be adopted internationally, and
planning. The availability of linguists who were TCCC partner nations will deploy with prehospital care competency.
trained and who could translate the TCCC Guidelines Nonetheless, the TCCC courses conducted at HKIA prove this
and other medical terminology was crucial for effective training can, and should, still occur while deployed. Adopting
implementation. When enough linguists were not pres- TCCC at the international level invites opportunity to refine
ent, the cadre used flashcards and electronic trans lation its implementation and structure, while further identifying
services to facilitate communication. Small groups facil- and resolving gaps. Data to describe prehospital outcomes of
itated instruction as well. TCCC-trained versus TCCC-untrained multilingual coalition
c. Scheduling flexibility. Since the HKIA R2E staff were populations warrants future investigation.
required for each course, real-world trauma patients
occasionally interrupted or delayed training. While the Regardless of nation or language, TCCC has a positive impact
rescheduling of training was inconvenient, unit leaders on improving the overall casualty response system, and com-
were very understanding. In fact, the R2E frequently petency in TCCC should be promulgated in the multinational
had extra help and manpower secondary to this situa- community. Through international adoption of TCCC princi-
tional awareness. ples and training, coalition personnel will have the knowledge,
Day 2 Tactical field exercises were organized with skills, and abilities to render aid, which may ultimately de-
base units to ensure trauma scenarios were not miscon- crease preventable deaths on the battlefield.
strued as real-world events and did not interrupt other
unit training activities. References
d. Culture sensitivities. The HKIA NATO base was under 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
(2001–2011): implications for the future of combat casualty care.
Turkish command. Training was not conducted during J Trauma Acute Care Surg. 2012;73(6):S431
religious ceremonies or times of Muslim prayer. Cul- 2. Defense Health Agency Joint Trauma System. Current Tactical
tural awareness of the students’ religious needs should Combat Casualty Care Guidelines. https://jts.amedd.army.mil/in-
be considered for any educational events in a multina- dex.cfm/committees/cotccc/guidelines. Accessed 4 August 2022.
tional environment. This was especially relevant when 3. Kragh JF Jr., Walters, TJ, Baer DG, et al. Survival with emergency
conducting simulation training in the vicinity of the on- tourniquet use to stop bleeding in major limb trauma. Ann Surg.
2009;249(1):1–7.
base mosque. 4. Kragh JF Jr., Littrel ML, Jones JA, et al. Battle casualty survival
Lastly, as mentioned above, the closing ceremony at with emergency tourniquet use to stop limb bleeding. J Emer Med.
the end of Day 2 with certificate presentation was very 2011;41(6):590–7.
important to the multinational community and fostered 5. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminating pre-
buy-in and enthusiasm amongst the students and their ventable death on the battlefield. Arch Surg. 2011;146(12):1350–8.
leadership. 6. Kragh JF Jr., Dubick MA, Aden JK, et al. US military use of tour-
niquets from 2001 to 2010. Prehosp Emerg Care. 2015;19(2):
5. AAR. An AAR was conducted at the conclusion of each 184–90.
course. These AARs aided in improving course delivery 7. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden
through feedback from students; the course was adapted hour policy on the morbidity and mortality of combat casualties.
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132 | JSOM Volume 23, Edition 1 / Spring 2023