The hard lessons learned over centuries of battlefield healthcare were all but
ignored until a landmark paper appeared in a 1996 issue of Military Medicine.
Previously, military guidelines for trauma management mirrored tactics used in
the civilian sector. Initiated by the elements of the Special Operations
Command, the new strategies outlined in 1996 were collectively referred to as
Tactical Combat Casualty Care (TCCC).
TCCC launched a total reassessment of practices with one
overarching goal: Decrease Preventable Combat Death at the point of wounding. These
new strategies based on historical
wounding patterns in combat also bear
a particular relevance to the operators
of Tactical Law Enforcement who share
many operational parallels with their military counterparts.
Instead of the civilian-based approaches of the past, integrated strategies
specific to combat realities continue to emerge. Compared to standard pre-hospital treatment modalities, which are fundamentally
based on blunt trauma, TCCC distinguishes itself from the norm by focusing primarily on the intrinsic tactical variables of
penetrating trauma compounded by prolonged evacuation times.
Today, TCCC is quickly becoming the standard of care for the tactical management of
combat casualties within the Department of Defense and is the sole standard of care dually endorsed by both
the American College of Surgeons and the National Association of EMT’s for casualty management in
TCCC is built around three definitive phases of casualty care:
Care rendered at the scene of the injury while both the medic and the casualty
are under hostile fire. Available medical equipment is limited to that carried
by each operator and the medic.
Rendered once the casualty is no longer under hostile fire. Medical equipment
is still limited to that carried into the field by mission personnel. Time
prior to evacuation may range from a few minutes to many hours.
Rendered while the casualty is evacuated to a higher echelon of care. Any
additional personnel and medical equipment pre-staged in these assets will be
available during this phase.
A Tiered System for Medical Equipment
During all phases of care the principle mandate of TCCC is the critical execution of the right interventions at the right time. Particularly in the tactical environment, good medicine
administered at the wrong time can often prove to be lethal. With this in mind Tactical Healthcare Professionals as well as Individual Warfighters/ Operators will both likely be involved in casualty care at some level and must be trained in and armed with the appropriate medical equipment and procedures corresponding to each level of care. As illustrated below, our macro strategy equips each tier with
the critical equipment essential to managing trauma at each phase of casualty care. When
employed with Tactical Combat Casualty Care (TCCC) training standards, this
tiered approach can decrease Preventable Combat Death by as much as 90+%.
Col. Gray hit the nail on the head 85 years ago. Empirical research using data
from World War II until today elicited the same conclusion. The overwhelming
cause of preventable combat death continues to be extremity hemorrhage (see Figure 1).
However, until recently, neither warfighters nor tactical operators were trained or equipped to control
the life threatening hemorrhage so common to both operational arenas.