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