Page 46 - JSOM Summer 2025

1. Provider—Will the step cause harm to the provider? For Additional Metrics of the TSAT-B
example, will the step excessively expose the provider’s wet
hands to the elements, causing frostbite? Additional information is gathered on the TSAT-B during testing,
2. Casualty—Will the step cause additional harm to the ca- including the timing of each step. Individual step times can be
sualty? For example, will exposing the casualty’s chest to added together to get a total sub-task time. For example, during
perform a needle decompression cause frostbite or rapidly a blood sweep, the provider finds a hemorrhage. They then stop
decrease the casualty’s core body temperature? to apply a tourniquet. Having stopped the bleed, they resume
3. Procedure—Can the step be performed with the current the blood sweep. Adding the two separate instances of the blood
uniform, gear, and medical supplies? For example, can an sweep equals the total time it takes to do a sweep. Additionally,
intravenous line be flushed if the saline flush is frozen? individual step times can be added to equal the time a specific
portion of the casualty was exposed during the procedure.
Each step is graded independently on a binary scale, as a “go”
(pass) or “no-go” (failure) in each of the three categories. A In conjunction with step time, percentage body exposure is
failure in one category does not mean a failure in all catego- also being tracked. The “rule of nines,” a method that medical
6
ries. In addition, a no-go in one step does not automatically providers use to estimate the area of a skin burn, is being
mean the remaining steps are a no-go. The grader moves on implemented to estimate the amount of skin exposed to the
to the next step as if the last has passed. In this way, a clear extreme cold (see Figure 2).
picture results of which steps failed, why the steps failed, what
needs to be solved, and for the benefit of whom (e.g., provider Two numbers can be generated, depending on the detail re-
or casualty) for the entire task (see Figure 1). quired: primary and secondary exposure. Primary exposure
is direct skin-to-air exposure. Secondary exposure consists of
decreased body temperature not caused by direct exposure to
The TSAT-B can also be used to quantifiably evaluate differ-
ent methods of performing TCCC in the cold. The tasks can air. For example, if the thigh portion of the ECWCS layers is
be broken down to be as detailed as necessary by those using unzipped or cut to expose a thigh wound, a portion distal to
it. For example, in its current state, the blood sweep is a single the exposure could be considered a secondary exposure. This
step; however, if a group wants to compare a new method of act of cutting open the uniform has “broken the seal” of warm
performing a blood sweep on a casualty wearing the Extended air that was trapped within the layers. In this case, the pelvis
Cold Weather Clothing System (ECWCS), the blood sweep can may also be considered secondarily exposed. The percentage
be developed into a more specific technique. Two unique ver- of exposure can be tracked per step. It can also be tracked
sions of the task for comparison would result: the original blood as an accumulation during the task to determine a point of
sweep and the new blood sweep, which incorporates changes in maximum exposure. In this case, the provider or researcher
the detailed steps. Both tasks would be performed and graded uses a rule of nines diagram to indicate the total extent and
on the TSAT-B. They could then be compared quantitatively location of exposure. In the example of comparing a control
and qualitatively to determine if the new blood sweep method blood sweep to a newer method, quantifying exposure would
is more effective in the extreme cold than the original method. help determine if the new method was equally effective at

FIGURE 1 Example TSAT-B form. Data collection form for the task “Apply tourniquets.” Researchers document the time per step, hand temp,
exposure percentage, and changes in uniform. Participants grade each step in three categories and write comments if a “no-go” is given.
Humidity:
Ambient Blood: Y/N Volunteer ID: Participant
Temp (C): Wind: Location Trial ID: Observer
Exposure

Provider Casualty Procedure Hand Primary Secondary Uniform Change/

Time Steps Temp Comments
1. Take Body Substance Isolation (BSI)
2. Perform blood sweep (head to toe)
*Finds deep wound on right thigh
3. Expose and assess wound
4. Apply direct pressure
5. Apply extremity tourniquet utilizing a
Combat Application Tourniquet (CAT)
a. Remove CAT Tourniquet from aid bag
b. Position the CAT about two inches
above the injury site
c. Pull the free running end of the self-
adhering band tight and securely fasten
it back on itself
d. Twist the windlass rod until bleeding
has stopped
e. Lock the windlass rod in place with the
windlass clip

44 | JSOM Volume 25, Edition 2 / Summer 2025