Medicine: Tactical Combat Casualty Care (TCCC)

Description

TCCC is Trauama care to save your life or loved ones or a complete stranger. Rather out on your own with no cell service or immediate treatment that can be compelted prior to arrival of an ambulance.

Expectations and Outcomes

CUF is characterized as the care rendered to a casualty while still under effective fire. In this case, the first action is to return fire and take cover as fire superiority over the enemy is the best medicine to include the casualty remaining engaged if able. As an enemy is suppressed, casualties can move or be moved to more secure positions. The only medical treatment rendered in CUF is stopping life-threatening hemorrhage (bleeding). TCCC actively endorses and recommends the early and immediate use of tourniquets to control massive external hemorrhage of limbs. All other treatment should be delayed until the casualty can be moved to a more secure and covered position and transitioned to tactical field care.

TFC is care rendered by first responders or prehospital medical personnel (primarily medics, corpsman, and pararescuemen) while still in the tactical environment. TFC is focused on assessment and management using the MARCH acronym.

• Massive hemorrhage is managed through the use of tourniquets, hemostatic dressings, junctional devices, and pressure dressings.
• The Airway is managed by rapid and aggressive opening of the airway to include cricothyroidotomy for difficult airways.
• Respirations and breathing is managed by the assessment for tension pneumothorax and aggressive use of needle decompression devices to relieve tension and improve breathing.
• Circulation impairment is assessed and managed through the initiation of intravenous access followed up by administration of tranexamic acid (TXA) if indicated, and a fluid resuscitation challenge using the principles of hypotensive resuscitation. TCCC promotes the early and far forward use of blood and blood products if available over the use colloids and discourages the administration of crystalloids such as normal saline (sodium chloride).
• Hypothermia prevention is an early and critical intervention to keep a traumatized casualty warm regardless of the operational environment.

Continued assessment and management in TFC includes treating penetrating eye trauma, assessing for traumatic brain injury or head injuries, treating burns, splinting fractures, and dressing non-life-threatening wounds. TCCC promotes the early and aggressive use of analgesia (pain management) on the battlefield through the administration of Ketamine and/or Oral Tranmuccossal Fentanyl for casualties with moderate to severe pain. TCCC also promotes the early administration of oral and intravenous or intramuscular antibiotics. The remainder of TFC is dedicated is reassessment of injuries and interventions, documentation of care, communicating with tactical leadership and evacuation assets. TFC culminates with packaging a casualty for evacuation and then evacuating by available air, ground, or maritime assets.

TACEVAC care encompasses the same assessment and management included in TFC with additional focus on advanced procedures that can be initiated when en route to a medical treatment facility. The caveat of TACEVAC is the evacuation means and care may or may not be dedicated medical platforms such as a MEDEVAC helicopter. TACEVAC can also include the evacuation of casualties on available non-medical assets and the provision of care in such circumstances.

Types

Tactical Casualty Care (TCCC / TECC)

Documentation Requirements

United States military guidelines for trauma life support in prehospital combat medicine, designed to reduce preventable deaths while maintaining operation success. The TCCC guidelines are routinely updated and published by the Committee on Tactical Combat Casualty Care (CoTCCC), which is part of the Defense Committees on Trauma (DCoT) division of the Defense Health Agency (DHA).^[1] TCCC was designed in the 1990s for the Special Operations Command medical community. Originally a joint Naval Special Warfare Command and Special Operations Medical Research & Development initiative, CoTCCC developed combat-appropriate and evidence-based trauma care based on injury patterns of previous conflicts. The original TCCC corpus was published in a Military Medicinesupplement in 1996.^[2] TCCC has since become a Department of Defense (DoD) course, conducted by National Association of Emergency Medical Technicians.