Page 45 - JSOM Summer 2025

Task Analysis Tool to Evaluate

Tactical Combat Casualty Care in the Extreme Cold

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Justin P. Bequette, RN ; Andres Martinez Murillo, MS *;
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Marcus Caldera ; Jack Harris ; William D’Angelo, PhD 5
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ABSTRACT
Due to the evolving geopolitical strategy of near-peer nations, developed a novel tool to evaluate TCCC “Massive Hemor-
there has been a growing national interest in the Arctic region. rhage, Airway, Respirations, Circulation, Hypothermia/Head
However, Tactical Combat Casualty Care (TCCC) assessments trauma” (MARCH) protocols based on a task analysis ap-
and interventions have been shaped based on input from con- proach. The Task Step Analysis Tool-Binary (TSAT-B) has been
flicts such as Iraq and Afghanistan. They do not consider the matured through trauma manikin evaluations in extreme cold
unique factors seen in extreme cold environments. Naval Med- field environments. The TSAT-B research aims to document
ical Research Unit San Antonio has developed a task analysis gaps in procedures and material used at the point of injury in
tool, the Task Step Analysis Tool-Binary (TSAT-B), to evaluate extreme cold environments and provide a method to evaluate
the effects of extreme cold on tasks within the current TCCC novel techniques in extreme cold TCCC. These findings will
protocols. The tool was pilot-tested using a trauma manikin in then inform potential changes to guidelines and/or further re-
field environments in Alaska, with temperatures ranging from –2 search into material solutions.
to –35°C. As part of the TSAT-B, task steps are graded into three
categories (provider, casualty, and procedure). Steps are timed, The following is a description of how and why the TSAT-B
and hand temperature is measured before and after a task. Writ- was devised in enough detail to be reproducible for use by
ten and verbal feedback is used to enhance the binary (go/no- the Special Operations Forces (SOF) community, researchers,
go) two-alternative forced-choice. The TSAT-B has proven to be trainers, and line units to develop improvements in protocols,
a useful evaluation tool and is being offered to standardize how procedural techniques, and evaluation of the effectiveness of
current TCCC protocols and proposed changes are evaluated. devices for these austere environments.

Keywords: Tactical Combat Casualty Care; Tactical Combat The TSAT-B
Casualty Care protocols; Massive Hemorrhage; Airway;
Respirations; Circulation; Hypothermia/Head trauma; extreme The core of the tool consists of a set of tasks broken down into
cold; Arctic; task analysis linear sub-tasks and then further into the rudimentary steps.
For example, the application of a tourniquet is composed of
sub-tasks, including the blood sweep, the wound assessment,
and the tourniquet application. Each sub-task is then broken
Introduction
down into the steps needed to complete the sub-task.
As near-peer nations increasingly turn their sights to the Arctic
to gain political, economic, and military advantages, the U.S. In development, MARCH tasks and steps were taken from
government has published strategies to ensure the future safety MEDCoE PAM 350-10 and later cross-referenced with the
and stability of the U.S. and its ally nations. These strate- skill checklists on the Deployed Medicine website. These are
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gies will require evaluating and adapting our current methods go/no-go—style grading forms used to assess the knowledge
of conducting combat operations and how they are medi- and skills of providers performing trauma lanes, the latter be-
cally supported. The Tactical Combat Casualty Care (TCCC) ing the current standard for all branches of the Department of
Guidelines, developed during the prolonged conflicts in Iraq Defense. The TSAT-B uses a similar format of grading; how-
and Afghanistan, were methodically researched and improved ever, it has been altered to grade the steps themselves and not
in climates very different from those in this new Arctic region. the skills of the provider performing them.
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As medical research involving extreme cold environments has
ramped up in recent years, the community has voiced interest The goal of evaluating each step was to determine if and why
in having a standardized method of testing TCCC protocols. it could fail in the extreme cold. Three categories of failure
Naval Medical Research Unit (NAMRU) San Antonio has were determined to capture all eventualities:
*Correspondence to andres.martinezmurillo.civ@health.mil
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1 Justin Bequette is a former combat medic and current research engineer. Andres Martinez Murillo, Marcus Caldera, and Jack Harris are
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research engineers. Dr. William D’Angelo is a biomedical engineer. All authors are affiliated with Naval Medical Research Unit San Antonio
(NAMRU SA), San Antonio, TX.
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