Page 101 - JSOM Summer 2025

were some deaths that could have been prevented with sim- All medical guidelines need to be periodically updated, and
ple TCCC interventions such as tourniquets and hemostatic TCCC is no different. Tell Them Yourself describes how the
dressings. Committee on TCCC (CoTCCC) was established in 2001 as a
joint effort of the US Special Operations Command and Navy
When presented to the Commander of the U.S. Special Oper- Medicine. The authors discuss in detail how the CoTCCC be-
ations Command, these findings helped to fast-track TCCC came integrated with the Joint Trauma System (JTS) and be-
training and equipment to all Special Operators going into gan to take part in the weekly JTS quality assurance trauma
combat. As other U.S. military units became aware of the lives teleconferences. Combined with a monthly review by the
being saved on the battlefield by TCCC in Special Operations CoTCCC of the prehospital trauma care medical literature
Forces, TCCC concepts gradually spread throughout all de- and reviews of data contained in the Department of Defense
ployed U.S. military units. Trauma Registry, the JTS quality assurance program has
helped the CoTCCC to continually update TCCC recommen-
The founding of the Joint Trauma System in 2004, also led by dations as needed to reflect new evidence and experience.
COL Holcomb, provided the infrastructure needed to track
the care and outcomes of all U.S. casualties. This enabled re- The book also discusses in detail all of the new – or rediscov-
searchers like COL Brian Eastridge to document the fact that ered – medical interventions that TCCC has pioneered. There
24% of all U.S. combat prehospital fatalities had died from are chapters devoted to tourniquets, hemostatic dressings,
survivable or potentially injuries and COL Russ Kotwal to prehospital blood transfusions, the “combat airway”, tension
report that the 75th Ranger Regiment, which had adopted pneumothorax, open pneumothorax, tranexamic acid (TXA),
TCCC in 1997, had no preventable or potentially preventable Triple Option Analgesia and other medical innovations led by
prehospital combat fatalities. This dramatic contrast in lives TCCC.
saved became the prime moving force for TCCC to be desig-
nated as the U.S. military standard. The authors have succeeded in providing a very complete over-
view of the development of Tactical Combat Casualty Care.
In the civilian sector, the concepts of TCCC were translated The many combat examples make the book very interesting
slowly into use. TCCC had an early connection with Dr. Nor- and the complete bibliography at the end provides the reader
man McSwain and the National Association of Emergency with a very large database with which to review the evidence
Medical Technicians (NAEMT). Dr. McSwain believed in the that supports TCCC recommendations.
need for a better relationship between military medical profes-
sionals and their civilian colleagues and ensured that Tactical For anyone interested in prehospital trauma care, accord-
Combat Casualty Care was included as an additional chap- ing to former USSOCOM Commander Admiral William H.
ter in the PHTLS textbook from the 4th edition onwards. But McRaven, this book is a must-read. In his words: “I have never
as late as 2008-2009, the use of tourniquets, which had by been more honored to recommend a book to the reader.”
then become a military standard, was virtually non-existent
in the civilian sector. In 2013, however, in the aftermath of the Tell Them Yourself – It’s Not Your Day to Die can be or-
horrific Sandy Hook mass shooting incident, the leadership of dered at https://jsom.us/TTY. European customers can order
Dr. Lenworth Jacobs and Dr. McSwain accelerated the use of at https://www.wero.de/en/p/buch-tell-them-yourself-it-s-not-
tourniquets in the civilian sector. The Hartford Consensus, led your-day-to-die.
by Dr. Jacobs and supported strongly by the American College
of Surgeons, came up with the THREAT acronym (2013) References
2,3
that stressed Threat suppression, Hemorrhage control, Rapid 1. Leeflang M., Woets R.: How Tactical Combat Casualty Care
Extrication to safety, Assessment by medical providers, Trans- (TCCC) Has Influenced Battlefield Trauma Care Worldwide. Ned-
port to definitive care. With the support of the White House, erl Mil Geneesk T 2021(74);3:141-147.
the Stop the Bleed program soon followed (2015). These 2. Leeflang M., Woets R., Veltman C.M.N.: History of MARCH,
4
CABCD, THREAT and S-CAB Acronyms. Prioritizing massive
programs encouraged the use of tourniquets and hemostatic hemorrhage in military and civil trauma care. Nederl Mil Geneesk
dressings by all potential first responders. Individuals bleeding T 2021(74);5:210-216.
from large extremity vessels have only a few minutes before 3. https://www.stopthebleed.org/resources-poster-booklet/
they bleed to death unless the hemorrhage is controlled. compressing-zones/
4. https://www.stopthebleed.org/

Book Review | 99