Tactical Combat Casualty Care Handbook Version 5

Tactical Combat Casualty Care (TCCC) has saved hundreds of lives during our nation's conflicts in Iraq and Afghanistan. Nearly 90 percent of combat fatalities occur before a casualty reaches a medical treatment facility. Therefore, the prehospital phase of care is needed to focus on reducing the number of combat deaths. However, few military physicians have had training in this area and, at the onset of hostilities, most combat medics, corpsmen, and pararescue personnel in the U.S. military have been trained to perform battlefield trauma care through civilian-based trauma courses. These courses are not designed for the prehospital combat environment and do not reflect current practices in the area of prehospital care. TCCC was created to train Soldiers and medical personnel on current best practices for medical treatment from the point of injury to evacuation to Role 3 facilities.

Tactical Combat Casualty Care (TCCC) has saved hundreds of lives during our nation's conflicts in Iraq and Afghanistan. Nearly 90 percent of combat fatalities occur before a casualty reaches a medical treatment facility. Therefore, the prehospital phase of care is needed to focus on reducing the number of combat deaths. However, few military physicians have had training in this area and, at the onset of hostilities, most combat medics, corpsmen, and pararescue personnel in the U.S. military have been trained to perform battlefield trauma care through civilian-based trauma courses. These courses are not designed for the prehospital combat environment and do not reflect current practices in the area of prehospital care. TCCC was created to train Soldiers and medical personnel on current best practices for medical treatment from the point of injury to evacuation to Role 3 facilities

Over 380 total pages ... 1. FULL TITLE: U.S. SPECIAL OPERATIONS COMMAND's TACTICAL TRAUMA PROTOCOLS (TTPs) TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) RECOMMENDED DRUG LIST (RDL) CANINE TACTICAL COMBAT CASUALTY CARE For SPECIAL OPERATIONS ADVANCED TACTICAL PARAMEDICS (SO-ATPs) - December 2016 CONTENTS By SECTION: SECTION 1: TACTICAL TRAUMA PROTOCOLS SECTION 2: TACTICAL MEDICAL EMERGENCY PROTOCOLS SECTION 3: RECOMMENDED DRUG LIST SECTION 4: CANINE COMBAT CASUALTY CARE (C-TCCC) SECTION 5: BURN QUICK REFERENCE GUIDE SECTION 6: NERVE CHARTS 2. FULL TITLE: Tactical Combat Casualty Care Handbook, Version 5 - May 2017 CONTENTS By CHAPTER: Chapter 1. Tactical Combat Casualty Care Overview Chapter 2. Tactical Combat Casualty Care Phases of Care Chapter 3. Tactical Combat Casualty Care Medical Equipment Chapter 4. MARCH/PAWS Treatment Algorithms Chapter 5. Tactical Combat Casualty Care-All Combatants Chapter 6. Tactical Combat Casualty Care-Medical Provider Appendix A. Tactical Combat Casualty Care Card Appendix B. Tactical Combat Casualty Care After Action Report Appendix C. Medical Triage Categories Appendix D. Medical Evacuation Precedence Categories Appendix E. 9-Line Request With MIST Report Appendix F. Prolonged Field Care Appendix G. Drug Reference Guide Appendix H. Medical Transition Guidelines in a Tactical Environment Appendix I. Medical Planning Functions Appendix J. Tactical Combat Casualty Care Background Appendix K. References

This handbook was previously distributed as a supplement to the Journal of Special Operations Medicine. The realm of special operations forces (SOF) medicine is a unique and ever-changing one that demands specialized training for our joint SOF. Managing trauma on today’s battlefield presents a dynamic array of challenges where limited resources can be rapidly overwhelmed. An austere environment, hostile gunfire, and delays in casualty evacuation (CASEVAC) are the norms for the special operations medic. The material in this handbook was gleaned from special operations medics operating in the Global War on Terrorism and other operational environments. It should not be viewed as a substitute for the professional training and judgment of special operations medics; rather, it is designed to be a hip-pocket reference on the tactics, techniques, and procedures (TTP) of SOF-relevant tactical combat casualty care. Key Lessons Ninety percent of combat loss of life occurs before casualties ever reach a military treatment facility (MTF); treatment prior to casualty evacuation is vital. Litter carries are fundamental for good patient care; they prevent further injury and get individuals off target as soon as possible. Rehearse manual carry methods prior to deployment. Every special operations warfighter should carry a tourniquet and be thoroughly familiar with its application. When managing multiple casualties, apply the principles of triage in classifying the priority of treatment and evacuation. Rehearse and employ all of the mechanics of CASEVAC from the point of injury to the handover at a MTF. This handbook provides a number of considerations when employing medical support to SOF in combat. The challenges are numerous, but the special operations medic must deliver medical care to save Soldiers’ lives. The collection of TTP in this handbook will enhance the medic’s ability to determine the optimum method to deliver casualty survival assistance.

Military surgeons must assume a leadership role in combat casualty care in circumstances that are far less than ideal. This handbook provides much of the information needed to tackle these issues and features state-of-the-art principles and practices of forward trauma surgery as used by military physicians in far flung locations around the globe. In this volume you’ll learn such integral skills as: Tactical field care Field dressing Applying pressure dressing Treating burns Treating inhalation injuries And more! Tactical Combat Casualty Care and Wound Treatment is the most trusted and up-to-date manual offered by the Department of Defense for military medical personnel in the field.

A decade of intense combat in two theaters has taught us many lessons about what works and what does not in the effort to accomplish that all-important mission of saving lives in battle. A severely injured Soldier today has about twice the likelihood of surviving his wounds compared to Soldiers in wars as recent as Vietnam. That progress is the result of many things: better tactics and weapons, better body armor and helmets, better trained and fitter Soldiers. But, the introduction of tactical combat casualty care (TCCC) throughout the Army has certainly been an important part of that improvement. TCCC is fundamentally different from civilian care. It is the thoughtful integration of tactics and medicine, but to make it work takes a different set of skills and equipment, and every Soldier and leader needs to understand it and practice it. This handbook is the result of years of careful study of the care of wounded Soldiers, painstaking research by medics and physicians, and the ability of leaders at all levels to see and understand the lessons being learned and the willingness to make the changes in equipment, training, and doctrine needed to improve the performance of the Army Health System. It is the best guidance we have at the time of publication, but new information, new techniques, or new equipment will drive changes in the future. Be assured that these performance improvement efforts will continue as long as American Soldiers go in harm’s way.

Tactical Combat Casualty Care Guidelines 28 October 2013 * All changes to the guidelines made since those published in the 2010 Seventh Edition of the PHTLS Manual are shown in bold text. The most recent changes are shown in red text. * These recommendations are intended to be guidelines only and are not a substitute for clinical judgment. Basic Management Plan for Care Under Fire 1. Return fire and take cover. 2. Direct or expect casualty to remain engaged as a combatant if appropriate. 3. Direct casualty to move to cover and apply self-aid if able. 4. Try to keep the casualty from sustaining additional wounds. 5. Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process. 6. Airway management is generally best deferred until the Tactical Field Care phase. 7. Stop life-threatening external hemorrhage if tactically feasible: - Direct casualty to control hemorrhage by self-aid if able. - Use a CoTCCC-recommended tourniquet for hemorrhage that is anatomically amenable to tourniquet application. - Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.

Historically in warfare, the majority of all combat deaths have occurred prior to a casualty ever receiving advanced trauma management. The execution of the Ranger mission profile in the Global War on Terrorism and our legacy tasks undoubtedly will increase the number of lethal wounds. Ranger leaders can significantly reduce the number of Rangers who die of wounds sustained in combat by simply targeting optimal medical capability in close proximity to the point of wounding. Directing casualty response management and evacuation is a Ranger leader task; ensuring technical medical competence is a Ranger Medic task. A solid foundation has been built for Ranger leaders and medics to be successful in managing casualties in a combat environment. The true success of the Ranger Medical Team will be defined by its ability to complete the mission and greatly reduce preventable combat death. Rangers value honor and reputation more than their lives, and as such will attempt to lay down their own lives in defense of their comrades. The Ranger Medic will do no less.