Tactical Combat Casualty Care (TCCC) is the model of military medical care designed to address the lives lost to preventable deaths. After a gunfight in Mogadishu in the early 1990s a serious look was given to the civilian pre-hospital, read EMS, model of trauma management which had been adopted by the US Military. It was decided this model was not appropriate nor compatible with the realities of armed combat. Further study going back through Vietnam, Korea, and the World Wars and further showed there were several preventable ways people were dying.
The data showed approximately 1/5 (20%) of injuries would succumb to their wounds no matter what care they receive within the first five to ten minutes of the injury. During the remainder of the first hour after receiving a wound approximately 10% more were succumbing to massive bleeding or airway issues.
By the six hour mark, breathing issues and some from shock were lost, accounting for another 10%, with this amount remaining consistent through the first day. Most additional losses being a result of shock. During the next two days shock then infections were the leading causes of death accounting for another 10%. Leaving only 50% of the original casualties alive after the first three days following their injuries.
It was also discovered on the battlefield most injuries were a result of penetrating injuries, not blunt force trauma as civilian EMS is structured to treat. This makes sense looking at it after the fact, civilians get hit by big slow moving things: cars mostly. Were the military gets hit by little fast moving stuff that goes through their bodies: shrapnel and bullets.
Additionally the study pointed out the differences between EMS:
- car accidents and medical illness
- paramedic protocol based
- ambulance based
- not long term care
And operational medical problems:
- out of hospital
- penetrating trauma
- independent medic (corpsman) based
- austere – not much equipment available and lots of terrain between you and home
- levels of treatment care
Upon studying this data a new treatment protocol was established to better address the preventable deaths. Being the military they also used an mnemonic, to help those of us who dine on crayons, MARCH, representing the order of treatment.
- M-Massive Hemorrhaging (Bleeding, lots of bleeding)
- A-Airway (that it remains open)
- R-Respirations (breathing in the ABCs)
- C-Circulation (that the blood is moving and minor bleeding has been addressed)
- H-Head Injuries/Hypothermia (both of these Hs need to be considered)
The phases of care are broken down into: care under fire, tactical field care, and evacuation. This is based on the level of security around you and the operational task happening.
Care Under Fire is as it sounds, the actions that can and should be performed if you are under fire or the scene is not safe. Usually limited to winning the fight, moving yourself from the place of injury, tourniquet application, and self-aid. The task at hand is stopping whatever it is that hurt you and getting to a safe place.
Tactical Field Care happens once the scene is “safe” but while being aware it could turn dangerous at any point moving forward and safety is still the priority. Here the medic if available, or another team member will perform a MARCH assessment and provide treatment care.
Evacuation Phase is the movement of the casualty out of the operational environment and to either: a dedicated evacuation team (ambulance in todays world) or back to a secure site where you can transfer both the security and medical responsibilities.
This process has proven to be rather successful in saving living in the recent wars. It has begun to take a foothold in the law enforcement world and has proven to save lives their as well. These concepts are just valid for the citizen concerned with his or her self-defense, as anytime someone is wiling to commit you harm someone is likely to get hurt, and how to patch holes is just as important as knowing how to make them.
-Joe
Outpost 95 