Page 137 - JSOM Winter 2024

Committee on Tactical Combat Casualty Care (CoTCCC) Update

Harold Montgomery, ATP

“Nothing gets a pass because ‘That’s the way we’ve always done it.”
—Frank Butler 1

he quote above from Dr. Frank Butler has truly become ■ Should NDC be removed from Combat Lifesaver (Tier 2)?
a running theme of the committee over the last couple ■ Is tube thoracostomy needed in TCCC or can it be deferred
Tof years and for the foreseeable future. We are taking to PCC?
a hard look at everything Tactical Combat Casualty Care ■ Should the emphasis on chest seals be re-evaluated?
(TCCC) has been doing for the last 25+ years. There is a pleth-
ora of data, studies, and publications from the last 20 years of Hemorrhagic Shock
combat operations as well as evolving feedback from ongoing ■ What is the priority of hemorrhagic shock resuscitation
global conflicts. All of this has prompted us to look at every over other TCCC interventions?
portion of the TCCC Guidelines to ensure we are producing ■ Should hypocalcemia be added to the lethal triad?
the evidence-based and best-practice–based guidelines for Role ■ Should calcium redosing be adjusted?
1 combat casualty care. ■ What does the current evidence suggest concerning redos-
ing tranexamic acid (TXA) in patients with ongoing non-
There will be changes to TCCC! Many of the forthcoming compressible torso hemorrhage in the setting of TCCC, as
changes will cause significant shifts in priorities of long- well as prolonged field care?
standing interventions and management schemes within ■ Is intramuscular administration of TXA a feasible, safe, and ef-
TCCC. These changes are based on evidence! Some of the fective alternative to intravenous/intraosseous administration?
changes will represent significant paradigm shifts for those ■ Is the speed of administration of 2g TXA associated with
that have been teaching and practicing TCCC for the last cou- adverse events?
ple of decades. As with all TCCC guideline changes, an accom- ■ Should the TCCC guidelines for circulation in tactical field
panying article will be published with details explaining each care (TFC) reflect assessment for shock and resuscitation,
change and presenting the supporting evidence. then TXA, before considering tourniquet conversion?

The dynamic nature of combat medicine necessitates continual Antibiotics
refinement of TCCC guidelines. Since its inception, TCCC has ■ Are antibiotics best suited for TCCC or PCC?
emphasized the importance of addressing the leading causes of ■ Do the antibiotic choices need to be updated?
preventable death on the battlefield: exsanguination, airway ■ Do antibiotic recommendations change if invasive proce-
compromise, and tension pneumothorax. However, as combat dures are performed?
scenarios evolve and new technologies and research emerge, ■ What is the best timing for antibiotic administration?
the guidelines must adapt. ■ Should topical administration of antibiotics be included in
TCCC?
Proposed Changes Under Review by COTCCC
Hemorrhage Control
Needle Decompression (NDC)/Chest Trauma ■ Should direct pressure be applied while devices are being
■ What is the incidence of tension pneumothorax as a cause/ prepared?
contributing factor in death? (updated data) ■ Should pressure points be used to control distal bleeding
■ Do the indications for decompression need to be updated? while devices are being prepared?
■ Do the recommendations for the site of decompression ■ Are prefabricated junctional devices superior to improvised
need to be changed? devices?
■ Is needle thoracostomy preferred over simple? ■ Are external abdominal pressure/abdominal tourniquet de-
■ How many needle attempts should be made? vices recommended in TCCC?
■ How deep should the needle be inserted? ■ Are devices that deliver hemostatic agents into the chest/
■ Does the size of the angiocatheter matter? abdomen recommended in TCCC?
■ Should simple thoracostomy be a Combat Medic/ Corpsman ■ Are any hemostatic agents preferred over devices for junc-
(Tier 3) skill? tional injuries?

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