Tactical Combat Casualty Care

1. Tactical Combat Casualty Care Charles W. Beadling, MD, FAAFP, IDHA, DMCC Center for Disaster and Humanitarian Assistance Medicine Department of Military and Emergency Medicine Uniformed Services University PART I

2. AGENDA • Objectives • Tactical vs. Civilian Trauma Care • Mortality in Combat • Stages of Tactical Care • Tactics, Techniques and Procedures (TTPs)

3. Learning Objectives • Students will compare and contrast the differences between civilian and tactical trauma. • The student will evaluate the importance of this unique body of knowledge (TCCC) that can decrease the KIA rate in modern warfare.

4. Learning Objectives • Know the three phases of care • Identify the top three causes of preventable combat mortality • List three methods of controlling hemorrhage in the field • Outline additional equipment and skills available with evacuation assets

5. Bottom Line Perform the CORRECT Intervention at the CORRECT Time

7. Advanced Trauma Life Support Advantages • Widely accepted in US and internationally • The standard of care in civilian hospitals Limitations in Combat • Intended for Advanced HCPs • Assumes availability of hospital diagnostic and therapeutic equipment • Assumes immediate surgical capability

8. The Problem: ATLS was never designed or intended to be used in the tactical environment.

9. Prior to TCCC Combat Fatalities 90% die before reaching MTF

10. Tactical Combat Casualty Care (TCCC) • Epidemiology of Trauma • Tactical Environment • Equipment and Tactics Techniques & Procedures • Significance to YOU *Graphic Photo Content*

11. Causes of Combat Wounds (WWI, WWII, Korea, Vietnam, Middle East)

12. Combat Morbidity & Mortality • Those that will survive regardless • Those that will die regardless • Those who will die from preventable deaths unless the proper life saving steps are taken immediately

13. Combat Mortality Killed in Action(86% KIA) versus Died of Wounds(12% DOW)

15. So What? • Understand Epidemiology = Develop Appropriate Critical Skill Sets • Understand Environment = Modify Skill Sets/Equipment to Maximize Benefit • Equipment • Training • Research

16. Causes of Death on the Modern Battlefield: Oct 01-Nov 04, n=495

17. How Can I Make a Difference? • Exanguinating extremity wounds – 61% • Tension pneumothorax – 33% • Airway obstruction – 6%

18. Critical Tasks • Control Hemorrhage • Open/Maintain Airway • Decompress a Tension Pneumothorax • Seal Open Chest Wound • Initiate Treatment for Shock • Employ Hypothermia Prevention XABC

19. TCCC Stages Of Care • Care Under Fire • Tactical Field Care • Combat Casualty Evacuation Care

20. Care Under Fire

21. Care Under Fire • Care rendered at the scene of the injury while rescuer and casualty are still under effective hostile fire. • First action: Return Fire! • Your no good, if you are DEAD

22. Care Under Fire • Return Fire/Gain Fire Superiority • Devise Rescue Plan • Direct Conscious Casualty in Self Aid (SABA) • Aggressive Hemorrhage Control • Tourniquet • Airway? • C-spine?

23. 60% Extremity Hemorrhage

24. Effective Tourniquets Save Lives

25. CAT

26. CAT Limitations • Improper training • Use when severe bleeding is not present • Loosening the device to allow intermittent return of blood flow • Not applying it tight enough • Removing it prematurely

27. Airway Obstruction

28. One simple Maneuver