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• Completion of TCCC is a prerequisite to PCC.
• The PCC guidelines provide a role-based set of best practices for Role 1 nonmedical and medical responders that build upon
TCCC.

Given the operational requirement for PCC, the CoTCCC, and JTS endorse the following:
1. TCCC is the foundation for any care in PCC and any Servicemember who receives PCC training should be fully qualified in
the appropriate role-based level of TCCC. 8
2. PCC training should be given to all Servicemembers and expeditionary civilians who will be in operational scenarios where
evacuation is likely to be delayed.
3. Role 1 nonmedical and medical responders need PCC education, training, and equipment in accordance with the JTS PCC
guidelines.
4. To decrease KIA rates and improve casualty outcomes, the DoD must maximize existing or establish new medical proficiency
opportunities within military treatment facilities or established medical military-civilian partnerships, to enhance all Role 1
nonmedical and medical responders’ clinical experience and critical thinking skills.

Given the operational requirement for PCC, the CoTCCC, and JTS recommend the following:
1. PCC-related research, development, testing, evaluation, and recommendations should focus on realistic interventions that can
be used within the Role 1 environment.
2. The minimum standards published by the JTS for a Joint PCC curriculum should be integrated into all common military
training and PCC pre-deployment training courses, regardless of course nomenclature.
3. The military departments should develop medical assemblage sets using the PCC planning paradigm for subsequent time-
based Role 1 care, for use across the full range of military operations.
4. Review and update all DoD component policy, publications, definitions, terms, and lexicons to communicate PCC best prac-
tices to the Secretaries of the Military Departments, Joint Staff, and Defense Health Agency.

References
1. Kotwal RS, et al. The effect of a golden hour policy on the morbidity and mortality of combat casualties. JAMA Surg. 2016;151(1):15–24.
doi:10.1001/jamasurg.2015.3104
2. Howard JT, Kotwal RS, Stern CA, et al. Use of combat casualty care data to assess the US military trauma system during the Afghanistan and
Iraq conflicts, 2001–2017. JAMA Surg. 2019;154(7):600–608. doi:10.1001/jamasurg.2019.0151
3. Fandre M. Medical changes needed for large-scale combat operations: observations from mission command training program warfighter
exercises. Military Review. 2020;May–June:37–45.
4. Defense Health Agency. Procedural Instruction 6040.03. Joint Trauma Lexicon. August 21, 2018.
5. Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF. Understanding combat casualty care statistics. J Trauma. 2006;60(2):397–
401. doi:10.1097/01.ta.0000203581.75241.f1
6. Chairman of the Joint Chiefs of Staff. Joint Publication 4-02. Joint Health Services. August 29, 2023.
7. Remley MA, Loos PE, Riesberg JC. Prolonged Casualty Care Guidelines 21 December 2021. J Spec Oper Med. 2022;22(1):18–47. doi:
10.55460/8IUQ-907J
8. Department of Defense. DoD Instruction 1322.24, Change 1, Medical Readiness Training. February 15, 2022

CoTCCC Voting Members & Position Statement Contributors

Primary Authors: Michael A. Remley; Dan Mosely; Sean Keenan; Travis Deaton; Harold Montgomery; Russ Kotwal; George
Barbee; Lanny Littlejohn; Justin Wilson; Curtis Hall; Paul Loos; John Holcomb; Jennifer Gurney.

Committee on Tactical Combat Casualty Care (CoTCCC)
CMSgt Shawn Anderson MAJ Chris Gonzales, PA Maj D. Marc Northern, MD
LTC Michael April, MD COL Jennifer Gurney, MD Mr. Keith O’Grady
CAPT Sean Barbabella, DO LtCol Christopher Hewitt LtCol Lorenzo Paladino, MD
LTC George Barbee, PA HMCM Christopher Huse SFC Justin Rapp
HMCS Joshua Beard MSG Christopher Hutchison MSG Michael Remley
SFC Hunter Black COL Jay Johannigman, MD HMCM Tyler Scarborough
HMSC Antonio Boyd CDR Joseph Kaleiohi, PA Col Stacy Shackelford, MD
MSG Cyril Clayton Mr. Win Kerr CMSgt Travis Shaw
SGM Curt Conklin LTC Ryan Knight, MD CSM Timothy Sprunger
COL Lance Cordoni, MD LCDR Eric Koch, MD HM1 Jonathon Stringer
CAPT Virginia Damin, RN CDR Joseph Kotora, MD CAPT Matthew Tadlock, MD
CAPT Travis Deaton, MD SrA Oliver Kreuzer COL Micheal Tarpey, MD
Mr. Michael Eldred CAPT Lanny Littlejohn, MD HMCM Jeremy Torrisi
MAJ Andrew Fisher, MD CPT John Maitha, PA CDR Russell Wier, DO
SGM Matthew Garrison Mr. Harold Montgomery MCPO Justin Wilson
LtCol Brian Gavitt, MD HMSC John Morey
Mr. William Gephart, PA, RN SCPO Richard Neading

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