Page 134 - JSOM Fall 2025

a. Urgent: High priority casualty with severe or critical common operating picture needed to manage all classes
life-threatening injury or illness who will only survive of MCM by streamlining coordination between TCCC
with immediate surgery, rapid damage control resuscita- responders, unit leaders, casualty evacuation teams, and
tion, or advanced medical treatment. higher roles of care.
b. Priority: Medium priority casualty with serious injury
or illness who will require surgery or advanced medi- Disclaimer
cal treatment at a delayed time (may include limb and The opinions or assertions contained herein are the private
eyesight-threatening injuries). views of the authors and are not to be construed as official or
c. Routine: Low priority casualty with minimal injury or as reflecting the views of the Defense Health Agency or the De-
illness who will require additional medical treatment, or partment of Defense. This recommendation is intended to be
expectant casualty for whom life-saving interventions a guideline only and is not a substitute for clinical judgment.
will be minimized.
d. Establish casualty count by precedence and patient type Disclosures
to determine resource allocation and accountability. The authors have nothing to disclose.
4. Communicate casualty status and situation reports with
leaders and responders to inform tactical, logistical, and References
medical decision-making processes during TCCC. 1. Shackelford SA, Remley MA, Keenan S, et al. Evidence-based princi-
5. Continually reassess and communicate casualty evacuation ples of time, triage and treatment: Refining the initial medical response
categories during all TCCC phases of care. to massive casualty events. J Trauma Acute Care Surg. 2022;93(2S
Suppl 1):S160–S164. doi:10.1097/TA.0000000000003699
6. Casualties with an altered mental status, secondary to in- 2. Kamler JJ, Taube S, Koch EJ, Lauria, MJ, Kue RC, Rush SC. Effec-
jury, illness, or mind-altering analgesia, should have weap- tiveness of and adherence to triage algorithms during prehospital
ons and communication equipment disabled or removed. response to mass casualty incidents. J Spec Oper Med. 2023;23
(1):59–66. doi:10.55460/73Y0-FSLB
3. Rush SC, Lauria MJ, DeSoucy ES, et al. Limitations of Triage in
Considerations for Further Research and Military Mass Casualty Response: A Case Series. J Spec Oper Med.
Development 2024;24(3):62–66. doi:10.55460/0GO5-QW03
4. Shackelford SA, Del Junco DJ, Mazuchowski EL, et al. The golden
Given the operational requirements for triage in TCCC, sev- hour of casualty care: Rapid handoff to surgical team is associated
eral critical actions are recommended: with improved survival in war-injured US service members. Ann
Surg. 2024;279(1):1–10. doi:10.1097/SLA.0000000000005787
• Integrate advanced wearable technologies, such as real-time 5. Joint Publication 4-02, Joint Health Services. August 29, 2023. Ac-
vital signs monitors, to provide responders and leaders cessed March 17, 2025. https://jdeis.js.mil/jdeis/index.jsp?pindex=2.
with immediate, accurate data on casualties’ conditions 6. Deaton TG, Drew B, Montgomery HR, Butler FK Jr. Tactical
to enhance rapid tactical, logistical, and medical decision- Combat Casualty Care (TCCC) Guidelines: 25 January 2024. J
Spec Oper Med. 2024;24(1):100–108. doi:10.55460/QT3B-XK5B
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• Develop and implement artificial intelligence–driven triage sponse to mass casualty events: move, treat, transport. J Spec Oper
algorithms to prioritize response and treatment based on in- Med 2024;24(3): 24–29. doi:10.55460/X38F-P3RH
jury severity, resource availability, operational constraints, 8. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Associ-
environmental limitations, and evacuation timelines to in- ation of prehospital blood product transfusion during medical
crease decision speed and reduce errors during MCM. evacuation of combat casualties in Afghanistan with acute and 30-
day survival. JAMA. 2017;318(16):1581–1591. doi:10.1001/jama.
• Enhance institutional, organizational, and self-development 2017.15097
learning strategies, techniques, and technologies to provide 9. Glassberg E, Lipsky A, Abramovich A, Sergiev I, Hochman O, Ash
personnel with standardized no-, low-, and high-fidelity N. A dynamic mass casualty incident at sea: Lessons learned from
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• Enhance existing battlefield technologies to inform ma-
chine learning and data fusion technologies, such as The PMID: 40992358; DOI: 10.55460/ZC6P-YS4G
Maven Smart System, to provide leaders with the requisite

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