06-18, TCCC Handbook - GlobalSecurity.org

1 FOR OFFICIAL USE ONLYMay 06No. 06-18 Tactics, Techniques, and ProceduresCenter for Army Lessons Learned (CALL)Fort Leavenworth, KS 66027-1350 HANDBOOKHANDBOOKF orewordThe original guidelines for tactical combat casualty care ( tccc ) were publishedin 1996. The Committee on tactical combat casualty care (CoTCCC) has updatedthese guidelines several times and the most recent revisions will be published laterthis year. The application of tccc principles during combat has proven highlyeffective and is a major reason combat deaths in Operation Iraqi Freedom (OIF) andOperation Enduring Freedom (OEF) are lower than in any other conflict in thehistory of the United States. It is imperative, then, that all military medicalpersonnel become familiar with the concepts and practices of Handbook is a one-stop, hip-pocket reference for all medical personnel, fromthe combat medic to the provider, on the tactics, techniques, and procedures (TTP)of tccc .

2 While this Handbook s contents are derived from the recommendations ofthe CoTCCC and lessons learned in OIF/OEF, it should not be seen as a substitutefor the professional training and judgment of medical personnel. Rather, thishandbook is meant to serve as a quick reminder of the TTP of tccc for medicalSoldiers in the primary mission of all military medical personnel in the field is to treat thecombat wounded and save lives. This task can be incredibly difficult due to thecomplex medical needs of wounded Soldiers and the tactical situations in whichthese injuries occur. The purpose of this Handbook is to support medical Soldiers asthey strive to meet their most noble goal: to save lives and conserve the fightingstrength. Steven MainsColonel, ArmorCenter for Army Lessons LearnedTactical combat casualty care HandbookTable of ContentsForewordChapter 1: tactical combat casualty Care1 Chapter 2: tactical combat casualty care Procedures25 Appendix A: Triage Categories51 Appendix B: Evacuation Categories53 Appendix C: 9-Line Medical Evacuation55 Appendix D: combat Pill Pack57 Appendix E: Improved First Aid Kit59 Appendix F: Warrior Aid and Litter combat casualty Kit61 Appendix G: Aid Bag Considerations63 Appendix H: National Stock Numbers65 Appendix I: References/Resources67 Center for Army Lessons LearnedDirectorColonel Steven MainsManaging EditorDr.

3 Lon SeglieCALL AnalystMajor Andrew DoyleContributing AuthorDonald L. Parsons, PA-C,MPASE ditorJohn PenningtonGraphic ArtistMark OsterholmFor Official Use OnlyiTACTICAL combat casualty care HANDBOOKThe Secretary of the Army has determined that the publication of this periodical isnecessary in the transaction of the public business as required by law of theDepartment. Use of funds for printing this publication has been approved byCommander, Army Training and Doctrine Command, 1985, IAW AR otherwise stated, whenever the masculine or feminine gender is used, bothare : Any publications referenced in this newsletter (other than the CALL newsletters), such as ARs, FMs, and TMs, must be obtained through your pinpointdistribution information was deemed of immediate value to forces engaged inthe Global War on Terrorism and should not be necessarily construedas approved Army policy or information is furnished with the understanding that it is to beused for defense purposes only, that it is to be afforded essentially thesame degree of security protection as such information is afforded bythe United States, and that it is not to be revealed to another country orinternational organization without the written consent of the Center forArmy Lessons Official Use OnlyCENTER FOR ARMY LESSONS LEARNEDC hapter 1 tactical combat casualty CareSection I.

4 IntroductionTactical combat casualty care ( tccc ) is the prehospital care rendered to acasualty in a tactical , combat environment. The principles of tccc arefundamentally different from those of traditional civilian trauma care , where mostmedical providers and medics train. These differences are based on both the uniquepatterns and types of wounds that are suffered in combat and the tactical conditionsmedical personnel face in combat . Unique combat wounds and tactical conditionsmake it difficult to determine which intervention to perform at what time. Besidesaddressing a casualty s medical condition, responding medical personnel must alsoaddress the tactical problems faced while providing casualty care in combat . Amedically correct intervention at the wrong time may lead to further casualties. Putanother way, good medicine may be bad tactics, which can get the rescuer andcasualty killed. To successfully navigate these issues, medical providers must haveskills and training oriented to combat trauma care , as opposed to civilian traumacare.

5 Unfortunately, many military medical providers and medics lack and woundsOn the battlefield, the prehospital period is the most important time to care for anycombat casualty . Up to 90 percent of combat deaths occur before a casualty reachesa medical treatment facility. This highlights the primary importance of treatingbattlefield casualties at the point of injury, prior to casualty evacuation(CASEVAC) and arrival at a treatment , combat deaths result from: 31 percent: Penetrating head trauma. 25 percent: Surgically uncorrectable torso trauma. 10 percent: Potentially correctable surgical trauma. 9 percent: Exsanguination. 7 percent:Mutilating blast trauma. 5 percent: Tension pneumothorax (PTX). 1 percent: Airway obstruction/injury. 12 percent: Died of wounds (mainly infection and shock).For Official Use Only1 tactical combat casualty care HANDBOOKA significant percentage of these deaths (highlighted above in bold type) arepotentially avoidable with proper, timely intervention.

6 Of these avoidable deaths,the vast majority are due to exsanguination and airway or breathing difficulties,conditions that can and should be addressed at the point of injury. It has beenestimated that of all preventable deaths, 90 percent of them can be avoided with thesimple application of a tourniquet for extremity hemorrhage, the rapid treatment ofa PTX, and the establishment of a stable the battlefield, casualties will fall into three general categories: Casualties who will die, regardless of receiving any medical aid. Casualties who will live, regardless of receiving any medical aid. Casualties who will die if they do not receive timely and appropriatemedical addresses the third category of casualties, those who require the mostattention of the medical provider during versus advanced trauma life support (ATLS)Trauma care training for military medical personnel traditionally has been based onthe principles of the civilian Emergency Medical Technicians Basic Course andbasic and advanced trauma life support.

7 These principles, especially ATLS, providea standardized and very successful approach to the management of civilian traumapatients in a hospital setting. However, some of these principles may not apply inthe civilian prehospital setting, let alone in a tactical , combat prehospital phase of casualty care is the most critical phase of care for combatcasualties, accounting for up to 90 percent of combat deaths. Furthermore, combatcasualties can suffer from potentially devastating injuries not usually seen in thecivilian setting. Most casualties during combat are the result of penetrating injuries,rather than the blunt trauma seen in the civilian setting. combat casualties may alsosuffer massive, complex trauma, such as traumatic limb amputation. In addition tothe medical differences between civilian and combat trauma, several other factorsaffect casualty care in combat , including the following: Hostile fire may be present, preventing the treatment of the casualty .

8 Medical equipment is limited to that carried by mission personnel. tactical considerations may dictate that mission completion takeprecedence over casualty care . Time until CASEVAC is highly variable (from minutes to hours or days). CASEVAC may not be possible, based on the tactical Official Use OnlyCENTER FOR ARMY LESSONS LEARNEDTCCC goalsTCCC presents a system to manage combat casualties that considers the issuesdiscussed above. An important guiding principle of tccc is performing the correctintervention at the correct time in the continuum of field care . To this end, tccc isstructured to meet three important goals: Treat the casualty . Prevent additional casualties. Complete the of careIn thinking about the management of combat casualties, it is helpful to divide careinto three distinct phases, each with its own characteristics and limitations: care under fireis the care rendered at the point of injury while both themedic and the casualty are under effective hostile fire.

9 The risk ofadditional injuries from hostile fire at any moment is extremely high forboth the casualty and medic. Available medical equipment is limited tothat carried by the medic and the casualty . tactical field careis the care rendered by the medic once he and thecasualty are no longer under effective hostile fire. It also applies tosituations in which an injury has occurred on a mission, but there hasbeen no hostile fire. Available medical equipment is still limited to thatcarried into the field by mission personnel. Time to evacuation may varyfrom minutes to hours. combat CASEVAC careis the care rendered once the casualty has beenpicked up by an aircraft, vehicle, or boat. Additional medical personneland equipment that has been prestaged in these assets should be availableduring this phase of casualty following chapters and sections of this Handbook will present a discussion ofeach stage of tccc , as well as instructions for the procedures tccc Official Use Only3 tactical combat casualty care HANDBOOKS ection II: care under fireCare under fire is the care rendered by the rescuer at the point of injury while heand the casualty are still under effective hostile fire.

10 The risk of additional injuriesat any moment is extremely high for both the casualty and the rescuer. The majorconsiderations during this phase of care are: Suppression of hostile fire. Moving the casualty to a safe position. Treatment of immediate life-threatening care during the care under fire phase is complicated by several tacticalfactors. First, the medical equipment available for care is limited to that which iscarried by the individual Soldiers and the rescuers. Second, the unit s personnelwill be engaged with hostile forces, and, especially in small-unit engagements, willnot be available to assist with casualty treatment and evacuation. Third, the tacticalsituation prevents the medic or medical provider from performing a detailedexamination or definitive treatment of casualties. Furthermore, these situationsoften occur during night operations, resulting in severe visual limitations whiletreating the actionsThe best medicine on the battlefield is fire superiority.