0INTRO TCCC

8/8/2019 0INTRO TCCC

http://slidepdf.com/reader/full/0intro-tccc 1/39

Tactical Combat Casualty CareFebruary 2009

Introduction



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



Why Are We Doing Better?

• Improved Personal Protective

• Tactical Combat Casualty Care• Faster evacuation time

4

Holcomb et al J Trauma 2006



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

5

e er o ea a rs

10 June 2008



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

6



•

and civilian pre-hospital trauma care•

combat casualty care

•

• DESCRIBE the phases of care in TCCC

7



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

8

combatant



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 .



10



(Data based on the Wound Data Munitions Effectiveness Team (WDMET) during the Vietnam War between 1967 and 1969)

11



Point of Woundin Care

on the battlefield

• Hemorrhage from extremity

• ens on pneumo orax

12

• Airway problems



13Click on picture to start video



Tension Pneumothorax

Air escapes from

injured lung –

chest

Air ressure

collapses lung andpushes on heart

14

Heart compressed - not able

to pump well



Airway Trauma

15



Civilian Trauma Care Setting



Tactical Trauma Care Setting –

rapne oun n t e n u us

17



Factors Influencing Battlefield

Casualty Care

•

Hostile fire• Darkness

• Extreme environments

• Mountain• Desert

• Limited medical equipment

• Possible prolonged evacuation time• Unit’s mission

• Tactical flow



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

19



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

20

a e e rauma care as some mes een s ow o

change.



Tourniquets in WWII

o pr

“We believe that the strap-and-buckle

in most instances under fieldconditions…it rarely controls bleeding

”.

21



Vietnam

Over 2500deaths occurredin Vietnamsecondary to

from extremityw n . Thcasualties had noother injuries.



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.

23



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)

24



Tourniquets – Beekley et al

ourna o rauma

• st

• 165 casualties with severe extremity trauma

• Seven deaths

•

preventable had an adequate prehospital tourniquet

been laced

25



Tactical Combat Casualty

are n pec a pera ons

Military Medicine SupplementAugust 1996

26



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

27

s ory.



Three Objectives of TCCC

• rea e casua y

• Prevent additional casualties• Complete the mission

28



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

29

• om at me c nput to gu e nes



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;

30

,

corpsmen, and PJs



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



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

32

TIME is critical



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.

33



Phases of Care in TCCC

• Care Under Fire

• Tactical Field Care

•

Evacuation Care

34



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.

35



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

36

.



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.

37



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!

38




• Three phases of care in TCCC• are n er re

• Tactical Field Care• TACEVAC Care

39




• TCCC – desi ned for combat

• NOT designed for civilian trauma settings• n c v an se ngs, use c v an s an ar s

40

0INTRO TCCC

Documents

Transcript of 0INTRO TCCC