Tactical Combat Casualty Care HM 1 EXWSSDVPJ Austine

Tactical Combat Casualty Care HM 1 (EXW/SS/DV/PJ) Austine Suva EODMU-5 DMT/IDC Overall Classification: UNCLASSIFIED//FOR OFFICIAL USE ONLY

OBJECTIVES • EXPLAIN: the goals of TCCC. • DISCUSS: the three phases of care: 1. Care Under Fire 2. Tactical Field Care 3. Tactical Evacuation • DISCUSS: the M. A. R. C. H. algorithm. • EXPLAIN: how to apply the M. A. R. C. H. algorithm within the three phases of care. UNCLAS//FOUO

WHAT IS TCCC? • TCCC - Tactical Combat Casualty Care • System used to treat injuries in a pre-hospital combat environment. • Started as a Special Operations research effort, now used by all forces. • Trauma management plan that takes into account the unique challenges faced by combat medical personnel. • TCCC has helped U. S. combat forces achieve the highest casualty survival rate in history. UNCLAS//FOUO

GOALS OF TCCC 1. Treat the casualty. 2. Prevent additional casualties. 3. Complete the mission. UNCLAS//FOUO

TCCC APPROACH • Identify the causes of preventable death on the battlefield. • Address these causes aggressively. • Combine good medicine with good tactics. • The outcome of the injured often lies with the one who first provides care. • Almost 90% of all combat deaths occur before the casualty reaches a Medical Treatment Facility (MTF). • Taught to Corpsman, Medics, and non-medical combatants. UNCLAS//FOUO

THREE PHASES OF CARE • CARE UNDER FIRE - Treatment given under effective hostile fire. • TACTICAL FIELD CARE - Treatment given when no longer under effective hostile fire. • TACTICAL EVACUATION - Patient transport to higher level of care. UNCLAS//FOUO

M. A. R. C. H. ALGORITHM • M- Massive Hemorrhage: stop life threatening bleeding. – Tourniquet, Combat gauze. • A- Airway: open or bypass obstruction. – Head tilt chin lift, jaw thrust, nasopharyngeal (done by first responders). – Cricothyroidotomy, intubation (done by the medic). • R- Respiration: seal holes in chest, relieve tension pneumothorax. – Chest seals, needle decompression. • C- Circulation: assess and treat for shock. – Intravenous/intraosseus access, blood products better than clear fluids. • H- Head to Toe Sweep/Hypothermia: – – Treat additional wounds as you find them. Prevent hypothermia. Give pain medication. Give antibiotics. UNCLAS//FOUO

Applying MARCH to the three phases of care CARE UNDER FIRE • Firepower superiority is the best medicine on the battlefield: win the fight! • The mission may take priority over the patient. • M – Massive bleeding: • TOURNIQUET: the only treatment rendered during this phase. • Move the casualty from danger: single person drag, two person drag, Hawes carry, SEAL team 3 carry. THE MOST PREVENTABLE CAUSE OF DEATH ON THE BATTLE IS: EXTREMITY HEMORRHAGE UNCLAS//FOUO

Applying MARCH to the three phases of care TACTICAL FIELD CARE • Rapid treatment of the most serious wounds with the expectation of a reengagement with hostile forces at any moment. • Give care that is possible in the field with limited supplies. • Time to evacuation may vary from minutes to several hours or longer. M – Massive bleeding: reassess and treat. A – Airway: open airway. • Head tilt chin lift/jaw thrust • Nasopharyngeal airway (NPA) • Emergency cricothyroidotomy (done by qualified personnel) • Endotracheal intubation (done by qualified personnel) UNCLAS//FOUO

Applying MARCH to the three phases of care TACTICAL FIELD CARE R – Respiration: Check the chest for wounds and holes. Use the BEAR CLAW method to examine the area. • If you find a hole treat it with a vented seal or occlusive dressing. • If you find one hole there is probably a second. • If you treat the patient with a chest seal, be cautious that a pneumothorax may develop and need to be treated with a needle decompression. UNCLAS//FOUO

Applying MARCH to the three phases of care TACTICAL FIELD CARE C - Circulation • Check for distal pulses. • Look for signs of shock: weak radial pulses and altered mental status. • Decide if patient will need fluid resuscitation. • Establish intravenous or intraosseous access. • The fluid of choice is whole blood. • Hextend, hetastartch, lactated ringers, or normal saline can be used if blood products are not available. • Fluid Resuscitation is done by trained personnel. UNCLAS//FOUO

Applying MARCH to the three phases of care TACTICAL FIELD CARE H - Head to Toe Sweep: examination from head to toe, treating wounds as you find them. • Wounds: pack the wound, wrap it up, apply pressure dressings. • Broken bones: splint. • Burns: apply dry sterile dressing or plastic wrap. UNCLAS//FOUO

Applying MARCH to the three phases of care TACTICAL FIELD CARE H – Hypothermia: • It is easier to prevent hypothermia than it is to treat it. • Wrap with blankets, space blankets, or whatever is available. • Hypothermia prevents the body from forming clots. UNCLAS//FOUO

Applying MARCH to the three phases of care Pain Management • Depends on what is carried by the medic and what the injuries are. • The medic/qualified personnel on the team will provide the medication. • Pain management is a key factor in the treatment of the patient. • Pain medication in Combat Pill Pack. UNCLAS//FOUO

Applying MARCH to the three phases of care Antibiotics • Give to all casualties with open wounds. • Prevents death and disability from would infection. • Antibiotic in Combat Pill Pack. Mobic 15 mg Tylenol ER 650 mg, 2 caplets Moxifloxacin 400 mg UNCLAS//FOUO

Applying MARCH to the three phases of care TACTICAL EVACUATION • The Tactical Evacuation phase allows for additional medical personnel and equipment to be used. • Casualties need evacuation as soon as possible after significant injuries. • Evacuation asset may be a ground vehicle, aircraft, or boat. • Evacuation time is highly variable. § Call in a 9 Line over the radio. § Follow the 9 Line with a M. I. S. T. report. § Document injuries and treatment on TCCC casualty card. UNCLAS//FOUO

TACTICAL EVACUATION 3 Different Types of Evacuation: • MEDEVAC: evacuation using special dedicated medical assets marked with a Red Cross. – Non-combatant. • CASEVAC: evacuation using non-medical platforms. – May be combatant. • TACEVAC: tactical evacuation. – This term encompasses both types of evacuation above. UNCLAS//FOUO

TACTICAL EVACUATION 9 -Line • Line 1 - Location of pickup site. • Line 2 - Radio frequency/call sign/telephone number (if applicable). • Line 3 - Number of patients by precedence (Urgent/Priority/Routine). • Line 4 - Special equipment required (hoist, litter, etc. ). • Line 5 - Number of patients by type (Litter/Ambulatory). • Line 6 – Security at pickup site (secure, hostile). • Line 7 - Method of marking pickup site (smoke, strobe light, vehicle headlights, flare, cloth markings, etc. ) • Line 8 - Patients' nationality and status (military/civilian). • Line 9 - Terrain description (flat, grassy, wooded, etc. ). • Urgent: Evacuation is required as soon as possible. • Priority: Evacuation is required but may be deferred for more serious patient. • Routine: Evacuation is required within 24 hours or longer. UNCLAS//FOUO

TACTICAL EVACUATION M. I. S. T. Report • Mechanism of Injury • Injuries • Symptoms • Treatment TCCC Casualty Card • Similar to MIST report but written done on easy to fill out card. • Important information for medical providers. • Stays with casualty when transporting. UNCLAS//FOUO

QUESTIONS? Overall Classification: UNCLASSIFIED//FOR OFFICIAL USE ONLY