0INTRO TCCC
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Tactical Combat Casualty CareFebruary 2009
Introduction
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Comparison of Statistics for
, - Holcomb et al J Trauma 2006
The U.S. casualty survival rate in the GWOT isthe best in our nation’s histor .
or ar e nam
% CFR 19.1% 15.8% 9.4%
3Note: CFR is the Case Fatality Rate – thepercent of those wounded who die
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Why Are We Doing Better?
• Improved Personal Protective
• Tactical Combat Casualty Care• Faster evacuation time
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Holcomb et al J Trauma 2006
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TCCC
“I am writing to offer my congratulations for therecent dramatic advances in prehospital traumacare e vere y e . . m ary. u p erecent publications have shown that Tactical
Combat Casualty Care is saving lives on theatt e e .
. American College of Surgeons Committee on Trauma
Chairman of Prehospital Trauma Subcommittee
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e er o ea a rs
10 June 2008
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Mabry and McManus
en er an c oo
“The new conce t of Tactical Combat
Casualty Care has revolutionized the
mana ement of combat casualties in theprehospital tactical setting.”
Critical Care Medicine
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•
and civilian pre-hospital trauma care•
combat casualty care
•
• DESCRIBE the phases of care in TCCC
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Importance of the First
Responder
• Up to 90% of all combat deaths occurbefore a casualt reaches a MedicalTreatment Facility (MTF)
• The fate of the in ured often lies in thehands of the one who provides the first careto the casualty.
• Corpsman, medic, or pararescueman (PJ)
• Combat Lifesaver or non-medical
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combatant
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Differences Between Civilian andCombat Trauma
• The causes of trauma are different.
• The setting in which the trauma occurs is
different.• The individuals caring for the casualties are
different.
• Evacuation time is typically much longer in
the combat settin .
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(Data based on the Wound Data Munitions Effectiveness Team (WDMET) during the Vietnam War between 1967 and 1969)
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Point of Woundin Care
on the battlefield
• Hemorrhage from extremity
• ens on pneumo orax
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• Airway problems
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13Click on picture to start video
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Tension Pneumothorax
Air escapes from
injured lung –
chest
Air ressure
collapses lung andpushes on heart
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Heart compressed - not able
to pump well
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Tactical Trauma Care Setting –
rapne oun n t e n u us
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Factors Influencing Battlefield
Casualty Care
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Hostile fire• Darkness
• Extreme environments
• Mountain• Desert
• Limited medical equipment
• Possible prolonged evacuation time• Unit’s mission
• Tactical flow
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Prior Medical Trainin
modeled on civilian courses• ,
• BTLS, ATLS
• ra ne o s an ar o care n non- ac ca
(civilian) settings
• Tactical elements not considered
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Different Trauma Requires
Different Care Strategies
• Intuitive, BUT• Difficult to devise and implement
• No one group of medical professionals has all of the
skills and experiences necessary.• Trauma docs and combat medical personnel have
different skill sets. Both are needed to optimize
att e e trauma care strateg es.• Tourniquets are one striking example of how
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a e e rauma care as some mes een s ow o
change.
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Tourniquets in WWII
o pr
“We believe that the strap-and-buckle
in most instances under fieldconditions…it rarely controls bleeding
”.
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Vietnam
Over 2500deaths occurredin Vietnamsecondary to
from extremityw n . Thcasualties had noother injuries.
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Tourniquets in U.S Military
- s
• Old stra -and-buckle tourni uets
were still being issued.
• e cs an corpsmen were e ng
trained in courses where the were
taught not to use them.
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SOF Deaths in the GWOT
Annals of Surgery 2007
Fatalities – 12 Potentially Survivable)• Hemostatic dressings/direct pressure (2)
• Tourniquets (3)
• Faster CASEVAC or IV hemorrhage control (7)• Surgical airway vs intubation (1)
• Needle thoracostomy (1)
• PRBCs on helos (2)• Battlefield antibiotics (1)
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Tourniquets – Beekley et al
ourna o rauma
• st
• 165 casualties with severe extremity trauma
• Seven deaths
•
preventable had an adequate prehospital tourniquet
been laced
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Tactical Combat Casualty
are n pec a pera ons
Military Medicine SupplementAugust 1996
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TCCC• Originally a Special Operations research effort
• Trauma management plans that take into
medical personnel
. .
most allied countries
• as e pe . . com a orces oachieve the highest casualty survival rate in
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s ory.
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Three Objectives of TCCC
• rea e casua y
• Prevent additional casualties• Complete the mission
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TCCC Guidelines 1996
• Tourniquets
• Aggressive needle thoracostomy• Nasopharyngeal airways
• Surgical airways for maxillofacial trauma
• Tactically appropriate fluid resuscitation• Battlefield antibiotics
• Improved battlefield analgesia
• Combine good tactics and good medicine• Scenario-based training
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• om at me c nput to gu e nes
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Committee on Tactical
om a asua y are
•
• Originally at Naval Operational Medicine
• Now at the Defense Health Board
• em ers rom a serv ces an c v ansector
• rauma urgery, mergency e c ne,Critical Care, operational physicians;
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,
corpsmen, and PJs
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TCCC Updates 2003
an
•
• Intraosseous infusion devices• Combat Pill Pack
• Hypotensive resuscitation
with Hextend
• en any ozenges
• Moxifloxacin
• H othermia revention
• Management of wounded hostile
combatants
31*Endorsed by ACS COT and NAEMT
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Timing Is Everything
•
both a medical problem as well as a tacticalroblem.
• We want the best possible outcome for both
the casualt and the mission.• Good medicine can sometimes be bad tactics;
bad tactics can get everyone killed or cause the
mission to fail• Doing the RIGHT THING at the RIGHT
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TIME is critical
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TCCC Phases of Care
on the tactical situation.
• During the gunfight, attention is focused
rimaril on eliminatin the threat.• As the threat decreases, increasing focus
medical care for the casualties.
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Phases of Care in TCCC
• Care Under Fire
• Tactical Field Care
•
Evacuation Care
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Care Under Fire
first responder or combatant at the scene of e n ury w e e an e casua y are
still under effective hostile fire. Availablemedical equipment is limited to that
carried b the individual or b the medical
provider in his or her aid bag.
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Tactical Field Care
first responder or combatant once he and the
fire. It also applies to situations in which an
,hostile fire. Available medical equipment is still
personnel. Time to evacuation to a medical
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Tactical Evacuation Care
rendered once the casualty has been pickedup y an a rcra , ve c e or oa .
Additional medical personnel andequipment that may have been pre-staged
should be available in this hase of
casualty management.
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Summary of Key Points
•
markedly different from civilian settings.• Tactical and environmental factors have a rofound
impact on trauma care rendered on the battlefield.
• Good medicine can be bad tactics.• Approximately 18% of combat deaths today are
potentially preventable.
• Good first responder care is critical.
• TCCC will ive ou the tools ou need!
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Summary of Key Points
• Three phases of care in TCCC• are n er re
• Tactical Field Care• TACEVAC Care
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