Page 47 - JSOM Summer 2025

FIGURE 2 Rule of nines. Percentages are given to different areas of Future Goals
the body and help estimate how exposed a casualty is to the elements
during a task. A single point in the trial can be assessed or the trial The TSAT is now being optimized for NAMRU San Anto-
can be reviewed to assess each step. nio field and cold chamber studies. The binary scale is being
Graphic from Tactical Combat Casualty Care Card DD Form 1380. altered to give providers three options, which will be devel-
oped as the TSAT-Likert or TSAT-L. Step values will consist of
the following: “go”—The step passed without concern from
the provider; “conditional go”—The provider completed the
step but is concerned that the probability of passing is low;
“no-go”—The provider could not perform the step.

The TSAT tool has garnered interest from fellow researchers,
trainers at military cold-weather medicine schools, and med-
ical units providing point-of-injury care. As such, it is being
made available for research or protocol development needs.
Currently, the TSAT tool is being packaged (with instructions)
for dissemination and use by interested colleagues. It is for-
matted to allow others to adjust, add, or subtract steps in
current protocols or develop completely new protocols. The
additional variables to be captured as described above, can
be scaled to the needs and equipment capabilities of the user,
while still maintaining some uniformity.

A standardized method of testing TCCC protocols will allow
a comparison of results and a measurement of efficacy for new
finding a bleed, with the advantage of less cold exposure to the
casualty. methods and devices between variable and control groups and
between results from other community members. For SOF
units, medical line units, trainers and researchers evaluating
Provider hand temperature can also be recorded. Hand tem-
perature can be measured at the start and finish of a task us- adjustments to current TCCC procedures, a database of TSAT
ing an infrared camera such as the TG267 (Teledyne FLIR, studies could expedite the widespread adoption of novel pro-
Wilsonville, OR). While this can demonstrate an overall dif- tocols and treatments (extreme cold weather or otherwise) as
ference in hand temperature, it lacks resolution both in time the DoD prepares for the possibility of a near-peer conflict,
and spatially across the hand. Sensors mounted on the fingers contested in extreme environments.
that continually capture temperature throughout a task would
be preferable; they could show which sub-tasks or steps may If the TSAT is of interest, please contact the authors at NAMRU
cause a rapid drop in hand temperature. San Antonio.
Author Contributions
Finally, written qualitative input from the provider or re-
searcher performing the tasks can be gathered per step. Pro- WD conceived the study concept and obtained funding. JB
viders can participate in a recorded after-action review (AAR) developed the TSAT metric. All authors contributed to the de-
type interview in which they are asked to walk through the velopment of the TSAT tool. JB, AMM, and MC performed
protocol and discuss their experience. This doubles as a data analysis. JB wrote the first draft, and all authors read and
backup to their written comments and elicits additional infor- approved the final manuscript.
mation that was not written down. This can include a more
detailed discussion of the failed steps and possible methods for Disclaimer
completing the steps successfully. The authors are employees or contractors of the U.S. Govern-
ment. This work was prepared as part of their official duties.
Title 17, U.S.C., §105 provides that copyright protection un-
The TSAT has been written in two versions. The first version
separates MARCH into individual tasks to be performed der this title is not available for any work of the U.S. Govern-
separately. This was designed in anticipation of the provid- ment. Title 17, U.S.C., §101 defines a U.S. Government work
ers having to pause in the middle of tasks to rewarm their as a work prepared by a military Servicemember or employee
hands to prevent frostbite and warm their core to prevent of the U.S. Government as part of that person’s official duties.
hypothermia. Isolated tasks can also be used in cases where
only one task or sub-task needs to be examined. This can save The views expressed in this manuscript are those of the au-
time and resources. However, full trauma scenarios requir- thors and do not necessarily reflect the official policy or posi-
ing providers to remain in the elements longer, in the form tion of the Department of the Navy, Department of Defense,
of the second version, a polytrauma combining isolated tasks, nor the U.S. Government.
may more accurately illustrate detrimental effects to both the
casualty and the provider, unique to performing multiple as- All photos, imagery and graphics are property of the U.S. Navy,
sessments and treatments. For example, more providers may unless otherwise annotated.
note a progressive increase in hand numbness and a decrease
in fine motor skills as the polytrauma progresses, hampering Disclosures
task performance, compared to providers performing the tasks The authors have indicated they have no financial relation-
individually. ships relevant to this article to disclose.

Tool to Evaluate Tactical Combat Casualty Care in the Cold | 45