Well I just recently returned from the Joint Special Operations Medical Training Course and School to re-certify and get some of the latest info on any changes and where we are at in the field. Obviously to be a tactical athlete it is allot more than training for triathlons and carrying and M-4 and the real difference is the tactics. Medical skill is a huge combat multiplier and when it really hits the fan it is nice to have some basic skills to save some lives. I did not intend this to be an exhaustive medical training guide but instead a very basic review that can be used with additional more detailed installments included later. This is definitely a work in progress and with feed back and questions I would like to create a great discussion to help the guys who don’t have training otherwise. So please leave any comments and questions I think this could turn into something really helpful.
Tactical Combat Casualty Care is the discipline of providing care under fire and in the field with somewhat limited resources and a casevac between definitive care and the patient. The reason it is necessary is mostly due to the fact that the medical
development of the past 100 years is primarily in a hospital or at the very least a permissible environment, well until the special operations community got a hold of it anyway. I remember when I first became and 18D and I would talk to non special operations troopers about getting a tourniquet on before applying a field dressing and getting looked at like I just told them to clean the toilet with their toothbrush. Things change as they always do and now tourniquets get put on extremely quick even in the civilian world.
The Phases of TCCC
Notice I say “phases” and not steps or stages, the reason is because these phases don’t always occur in any order and not all phases exist in every situation. The phases we will talk about are: care under fire, tactical field care and tactical evacuation care.
Care Under Fire
Care under fire is generally rendered at the point of injury. Care under fire generally indicates a situation that still poses a threat to the casualty and other team members. The first step before any action is to take an inventory of the situation: is it safe? is medicine the best course of action? if medical action is required have you determined who requires care first? Often the best medical care is superior firepower.
1. Return fire, take cover
2. Direct casualty to cover and direct self aid.
ex. “hey get behind the truck and get a tourniquet on that bleeder and get back in the fight!”
3. Try to keep casualty from sustaining additional wounds
ie. Kill enemy and or throw out smoke to provide concealment METTC dependent
4. Stop immediate life threats
-remove from continuing injury
5. It is often best to defer airway management until Tactical field Care
Tactical Field Care
Once the immediate area is secure or there is a pause in action the medical personnel can at this point render more in depth care to the casualty. Get the 9-line out as soon as possible and get the chopper in the air or the trucks on the way, don’t forget to ask for more medical supplies in line 4 if your team is going to continue the mission after casevac.
1. Reassess the previous treatments and ensure that all immediate life threats are still being mitigated.
2. Begin managing airway, often positional changes can have a dramatic effect on increasing ease of breathing, if not counter indicated consider placement of a nasal pharyngeal airway.
3. Assess respirations including examining the torso and back for penetrating trauma.
ie. treat sucking chest wounds, difficulty breathing and method of injury gets a needle decompression.
4. Stop all other bleeders and consider converting tourniquets to pressure dressings.
5. Obtain IV access, asses for shock treat as needed.
6. Treat for hypothermia, get the blizzard bag out and cover up the patient.
7. Monitor vitals, pulse oximetry, heart rate, respirations.
8. Dress all other wounds:
ie. splints, treat burns, penetrating trauma
9. Provide pain meds if necessary. If level of consciousness is below alert or LOC is affected by pain meds remove weapon system from casualty and turn off casualties radio. Give pill pack to casualty
10. Document all care and keep documentation with patient.
When preparing for the evacuation process be sure to constantly reassess the treatments provided, as well as vitals, work of breathing and exposure to the elements. If using a litter be sure to snap the straps so the patient doesn’t get ejected from the litter in transport. If the patient doesn’t have a definitive airway and struggles to get up because of an obstruction allow the patient to assume a position of comfort. If during transport work of breathing increases consider a needle thoracentesis to relieve a pnuemothorax. If the patient is conscious and a head injury is suspected consider providing a MACE test for traumatic brain injury.
Disclaimer: Treating combat trauma is a very serious and dangerous activity. When possible always seek a higher level of care and err to the side of safety. This is not an explicit or implied block of instruction and should serve to refresh or review military training. In the absence of proficiency remember you may be the only care provider in the A.O. so use common sense. This is intended for a military audience and not is to be confused with civilian non combat treatment.