Tactical Combat Casualty Care (TCCC) as a Life-Saving Skill
First-responder protocols and evacuation procedures of the casualty in Tactical Combat Casualty Care (TCCC/T3C) are required to be implemented correctly in case of gunshot wounds and blast injuries.
90% of potentially preventable mortalities are due to bleeding.
First-responder protocols and evacuation procedures of the casualty in Tactical Combat Casualty Care (TCCC/T3C) are required to be implemented correctly in case of gunshot wounds and blast injuries.
Tactical Combat Casualty Care (TCCC or T3C) originated as a Naval Special Warfare biomedical research project in the early 1990s and was first published as a Military Medicine supplement in 1996. This research was stimulated by evidence showing that tactical medicine environment and care differed substantially from typical prehospital medicine. TCCC being performed on the battlefield makes these algorithms necessary and special. The battlefield conditions and limitations in local possibilities, as well as the disruptions that may occur in evacuation, have excluded the treatment options from civilian injury algorithms.
Unlike standard trauma management, TCCC starts with the medical evaluation of the casualty. In the primary evaluation of TCCC, much more emphasis is placed on early and massive hemorrhage control before starting the evaluation of the airway, respiration and circulation (ABC). The primary objectives of TCCC are to provide early, life-sustaining medical care to the casualty, limit further damage to the casualty, and lastly, achieve mission success. Compared to the civilian trauma elements in terms of time, location, and unavailability of the equipment, tactical combat casualty care has many negative differences, depending on factors such as location, climate, geographical area, and conflict severity. [2]
Phases of Care in TCCC
The primary objectives of TCCC are to provide early, life-sustaining medical care to the casualty, limit further casualties, and achieve mission success. TCCC is divided into three phases of care:
1. Care Under Fire (CUF)
2. Tactical Field Care (TFC)
3. Tactical Evacuation Care (TACEVAC).
1. Care Under Fire (CUF): This is the first objective of TCCC and begins once a casualty is established. The primary goal is fire superiority and movement of the casualty into cover. The only initial medical intervention during CUF is the early application of tourniquets for major hemorrhage control. It is important to use tactical tourniquets specially designed for this application.
There are some points that must be considered in tourniquet application:
• Tourniquets should be easily accessible and not be put under every other piece of equipment.
• Tourniquet placement is “high and tight”, meaning rapidly placed over the uniform, proximal to the wound, and tightened until bleeding is stopped.
• If the first tourniquet fails, place the second tourniquet just a bit more proximal, leaving the first in place.
• Do avoid placing the tourniquet on knee and elbow joint areas.
2. Tactical Field Care (TFC): This is the basis of EMS/medic or prehospital tactical care which is rendered once the appropriate cover has been achieved while still within the battlefield environment. Generally, medical care is provided through gear carried by the medical personnel. Care during TFC follows the MARCH algorithm (Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia). Ideally, massive hemorrhage has been controlled during CUF; if not, tourniquet placement is the first priority and then airway management focuses on maintaining a patent airway.
3. Tactical Evacuation Care (TACEVAC): This phase continues with ongoing monitoring and intervention encompassed through TFC during transport out of the tactical environment to the hospital facility. During this phase of care, airway intervention maneuvers can be performed along with ongoing evaluation and monitoring following the MARCH algorithm.
TCCC for the Future of Battlefield and Combat Casualty Care
Studies showed that the adoption of TCCC across the United States military services substantially improved soldier fatality rates in 2006. A study of fatality rates spanning from 1941 to 2005 showed improvement from 19.1% during World War II, and 15.8% during the Vietnam War, down to an all-time low of 9.4% during Iraq Operation.
In 2012, it was reported that the primary causes of death on the battlefield as hemorrhage, 91%; airway obstruction, 7.9%; and tension pneumothorax, 1.1%. Massive hemorrhage was found to include extremity wounds, 13.5%; junctional wounds, 19.2%; and truncal wounds, 67.3%. Because of this, the typical trauma primary survey has been rearranged from airway, breathing, circulation, and disability to follow the MARCH mnemonic of massive hemorrhage, airway, respiration, circulation, and hypothermia. [3]
The skills gained in Tactical Combat Casualty Care training are of critical importance in terms of providing medical care on time, increasing the chances of survival, and minimizing preventable deaths, especially for active-duty personnel during the battlefield.
CANiK Academy provides Medical Training Programs for the military and law enforcement personnel to develop crucial skills such as first-responder protocols and casualty evacuation in case of gunshot wounds and blast injuries.
EXPERIENCE TEACHES
REFERENCES
[1] Eksert, S. (2020). Analysis of anatomical localization and severity of injury in patients with blood transfusion in Urban Terrain Hospital. Turkish Journal of Trauma and Emergency Surgery. https://doi.org/10.14744/tjtes.2020.94789
[2] Kalemoğlu E, Kalemoğlu M. Güncel Bilgiler Işığında Taktik Muharebe Yaralı Bakımı. Hitit Med J 2022;4(3): 123 - 128 DOI: 10.52827/hititmedj.1099875
[3] Puryear B, Roarty J, Knight C. EMS Tactical Combat Casualty Care. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532260/
First-responder protocols and evacuation procedures of the casualty in Tactical Combat Casualty Care (TCCC/T3C) are required to be implemented correctly in case of gunshot wounds and blast injuries.
Tactical Combat Casualty Care (TCCC or T3C) originated as a Naval Special Warfare biomedical research project in the early 1990s and was first published as a Military Medicine supplement in 1996. This research was stimulated by evidence showing that tactical medicine environment and care differed substantially from typical prehospital medicine. TCCC being performed on the battlefield makes these algorithms necessary and special. The battlefield conditions and limitations in local possibilities, as well as the disruptions that may occur in evacuation, have excluded the treatment options from civilian injury algorithms.
Unlike standard trauma management, TCCC starts with the medical evaluation of the casualty. In the primary evaluation of TCCC, much more emphasis is placed on early and massive hemorrhage control before starting the evaluation of the airway, respiration and circulation (ABC). The primary objectives of TCCC are to provide early, life-sustaining medical care to the casualty, limit further damage to the casualty, and lastly, achieve mission success. Compared to the civilian trauma elements in terms of time, location, and unavailability of the equipment, tactical combat casualty care has many negative differences, depending on factors such as location, climate, geographical area, and conflict severity. [2]
Phases of Care in TCCC
The primary objectives of TCCC are to provide early, life-sustaining medical care to the casualty, limit further casualties, and achieve mission success. TCCC is divided into three phases of care:
1. Care Under Fire (CUF)
2. Tactical Field Care (TFC)
3. Tactical Evacuation Care (TACEVAC).
1. Care Under Fire (CUF): This is the first objective of TCCC and begins once a casualty is established. The primary goal is fire superiority and movement of the casualty into cover. The only initial medical intervention during CUF is the early application of tourniquets for major hemorrhage control. It is important to use tactical tourniquets specially designed for this application.
There are some points that must be considered in tourniquet application:
• Tourniquets should be easily accessible and not be put under every other piece of equipment.
• Tourniquet placement is “high and tight”, meaning rapidly placed over the uniform, proximal to the wound, and tightened until bleeding is stopped.
• If the first tourniquet fails, place the second tourniquet just a bit more proximal, leaving the first in place.
• Do avoid placing the tourniquet on knee and elbow joint areas.
2. Tactical Field Care (TFC): This is the basis of EMS/medic or prehospital tactical care which is rendered once the appropriate cover has been achieved while still within the battlefield environment. Generally, medical care is provided through gear carried by the medical personnel. Care during TFC follows the MARCH algorithm (Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia). Ideally, massive hemorrhage has been controlled during CUF; if not, tourniquet placement is the first priority and then airway management focuses on maintaining a patent airway.
3. Tactical Evacuation Care (TACEVAC): This phase continues with ongoing monitoring and intervention encompassed through TFC during transport out of the tactical environment to the hospital facility. During this phase of care, airway intervention maneuvers can be performed along with ongoing evaluation and monitoring following the MARCH algorithm.
TCCC for the Future of Battlefield and Combat Casualty Care
Studies showed that the adoption of TCCC across the United States military services substantially improved soldier fatality rates in 2006. A study of fatality rates spanning from 1941 to 2005 showed improvement from 19.1% during World War II, and 15.8% during the Vietnam War, down to an all-time low of 9.4% during Iraq Operation.
In 2012, it was reported that the primary causes of death on the battlefield as hemorrhage, 91%; airway obstruction, 7.9%; and tension pneumothorax, 1.1%. Massive hemorrhage was found to include extremity wounds, 13.5%; junctional wounds, 19.2%; and truncal wounds, 67.3%. Because of this, the typical trauma primary survey has been rearranged from airway, breathing, circulation, and disability to follow the MARCH mnemonic of massive hemorrhage, airway, respiration, circulation, and hypothermia. [3]
The skills gained in Tactical Combat Casualty Care training are of critical importance in terms of providing medical care on time, increasing the chances of survival, and minimizing preventable deaths, especially for active-duty personnel during the battlefield.
CANiK Academy provides Medical Training Programs for the military and law enforcement personnel to develop crucial skills such as first-responder protocols and casualty evacuation in case of gunshot wounds and blast injuries.
EXPERIENCE TEACHES
REFERENCES
[1] Eksert, S. (2020). Analysis of anatomical localization and severity of injury in patients with blood transfusion in Urban Terrain Hospital. Turkish Journal of Trauma and Emergency Surgery. https://doi.org/10.14744/tjtes.2020.94789
[2] Kalemoğlu E, Kalemoğlu M. Güncel Bilgiler Işığında Taktik Muharebe Yaralı Bakımı. Hitit Med J 2022;4(3): 123 - 128 DOI: 10.52827/hititmedj.1099875
[3] Puryear B, Roarty J, Knight C. EMS Tactical Combat Casualty Care. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532260/
