Tactical Combat Casualty Care

Abstract

Background: Prior to the onset of hostilities in Afghanistan, there had been very few significant advances in battlefield trauma care for the last 125 years. In 1996, the original Tactical Combat Casualty Care (TCCC) Guidelines were published in Military Medicine. TCCC is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield.Methods: The conflicts in Iraq and Afghanistan have been the longest continuous period of armed conflit in our nation’s history. During that time, TCCC has steadily evolved as additional prehospital trauma care evidence became available and as feedback from user medics, corpsmen, and pararescuemen was gained.Findings: TCCC has been in the forefront of advocating for battlefield trauma care advances, to include the aggressive use of tourniquets and hemostatic dressings for the control of life-threatening external hemorrhage; improved fluid resuscitation techniques for casualties who are in hemorrhagic shock; a focus on airway positioning and surgical airways to manage casualties with airway trauma; safer and more effective battlefield analgesia; the use of intraosseous vascular access when peripheral IVs are difficult to start; battlefield antibiotics; and combining good medicine with good small-unit tactics.Discussion: TCCC at the point in time has been well-documented to produce unprecedented decreases in preventable combat fatalities in military units that have trained all of their unit members – not just medics - in TCCC. This proven success has made TCCC the standard for battlefield trauma care in the US military and for the militaries of many of our allied nations. The Committee on TCCC and the Joint Trauma System work in close concert with civilian trauma colleagues through such initiatives as the Hartford Consensus, the White House Stop the Bleed campaign, and the development of National Association of Emergency Medical Technicians. These strategic partnerships have enabled TCCC advances in prehospital trauma care to be translated into civilian trauma care practice. Active shooter events, terrorist bombings, and the everyday trauma that results from motor vehicle crashes, household accidents, and criminal violence create the potential for many lives to be saved in the civilian sector as well. The Department of Defense’s Joint Trauma System, including the Committee on TCCC, has been recognized as a national resource and designated by Congress as the lead agency for trauma in the US Military.