Tactical combat casualty care ( TCCC )
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JANES said:
We have to be honest with ourselves when comparing experience. British and American militaries have a lot (re:tons of) combat experience. Canada has good troops, an excellent training system but only a few have any combat experience. The majority of those are not involved in training companies.'nuff said.
That was not an assumptive attack.....it was a preemptive strike. I'm very tired of the anti-USA bias that permeates our country.
starlight_cdn said:
Well your preemptive strike was friendly fire. Good job. Noted!
For the record, I have nothing against the US. I believe the CF should seriously look at the way the US does business on numerous topics and consider it for ourselves. Adopting it blindly would be niave, but consideration, especially from all their operations and lessons learn would be behoove us. Its a shame, sometimes it almost seems like the CF will purposely NOT adopt a tactic or peice of equipment because they feel they need something "Canadian", so instead they try to re-invent the wheel in the shape of a mapleleaf. Doesnt really role that well, but the troops sure look patriotic! or was it the politicians?
WRT experience, there are a lot more Americans, and they have a much more agressive foreign policy shall we say, so yes there will be more of them with "real" experience. But, maybe you should take your own advice and think outside the box. Not all the experience has to come from the conventional CDN Army. There are a lot of Canadians who have served in the US and British Forces with "real experience", CDN Ex-SOF, CDN's with overseas security experience for Brit security Coys, some even made it over with Blackwater and Triple Canopy before the State Dept shut down the hiring of Foreign Nationals, lets see who else?...Loads of Police officers with tons of good "real" experience including SWAT, a few TEMS paramedics, the list goes on, quite a few of which I personally know have loads of "real" experience and are or at least were involved in training. Its to bad they have to fly red white and blue before YOU will consider them "experienced". I don't have to prove that I'm not anti American, but I'm starting to think you should tell us how you're not anti-Canadian.
Back to the topic of the thread, and my original question, what are the Canadian Companies that exist, regardless of your opinion of their experience?
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MG34
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The simple fact is that the US Military does have a hell of a lot more experience,therefore thier military/ex-military trainers have a alot more experience. I have seen our Canadian medics in action while under fire and after a mass cas event,for the most part they performed adequately for the most part but are lacking in many of the skills required to operate beyond a clinical enviroment,on the other hand there is the St. John's Amb., and Red Cross to name a couple,that offer excellent training.
We can't even count on our own system to train the soldier in what is needed,as all the qualified MCpls and Sgts are too busy re-arranging bed pans or some damn thing than bother to conduct the training as needed. (Yes I know there is alot of admin in an 8 man/woman med section or UMS :
). Once we break our own medics from their hospital and civilian equavalency mindset and start thinking tactically maybe we will actually get the training we need, but as of now there are no Canadian companies that offer REAL and revalant TCCC training because none have been there or done that.
StarlightCDN, is not anti Canadian in his comments but is simple stating a fact,there are very small amounts of Canadians that have any operational experience in this field (no a tour cleaning bedpans in T-SG is not an operational experience). He has realized there is no option for training in canada and has gone out of the box so to speak,at least he was willing to make the leap and put quality training as a priority as opposed to some minimal "required' standard BS training provided in Canada.
BTW Blackwater does not hire foriegn nationals..that is done by other orgs working under the BW umbrella,SWAT or TRU,or ERT or what ever are not combat medics,different roles and mission parameters.
So there you have it,of course the short version is that there are no credible schools or organizations in Canada yet that teach TCCC or anything close to it that can back their experiences in combat, or have "dropped brass and gotten their hands bloody".
We can't even count on our own system to train the soldier in what is needed,as all the qualified MCpls and Sgts are too busy re-arranging bed pans or some damn thing than bother to conduct the training as needed. (Yes I know there is alot of admin in an 8 man/woman med section or UMS :
). Once we break our own medics from their hospital and civilian equavalency mindset and start thinking tactically maybe we will actually get the training we need, but as of now there are no Canadian companies that offer REAL and revalant TCCC training because none have been there or done that.StarlightCDN, is not anti Canadian in his comments but is simple stating a fact,there are very small amounts of Canadians that have any operational experience in this field (no a tour cleaning bedpans in T-SG is not an operational experience). He has realized there is no option for training in canada and has gone out of the box so to speak,at least he was willing to make the leap and put quality training as a priority as opposed to some minimal "required' standard BS training provided in Canada.
BTW Blackwater does not hire foriegn nationals..that is done by other orgs working under the BW umbrella,SWAT or TRU,or ERT or what ever are not combat medics,different roles and mission parameters.
So there you have it,of course the short version is that there are no credible schools or organizations in Canada yet that teach TCCC or anything close to it that can back their experiences in combat, or have "dropped brass and gotten their hands bloody".
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Yeah, right...see you in the next couple of weeks, when we are teaching you TCCC concepts as part of TSMT.MG34 said:
And for the record, it is NOT the NCOs who are unwilling or stopping this training, it is at a much higher pay grade level then us. If it takes the CDS and a Brigade Commander to push to get it...
I can't even get tourniquets for my UMS rifle company medics. :rage:
I agree its just that sufficent numbers have yet to be exposed those situations, whether real or simulated.
MG34 said:
Are you kidding? St.John's Amb and Red Cross offer excellent training? Is this sarcasm? Maybe for garritrooping, but these companies have no business teaching soldiers how to treat combat casualties. They do a good job teaching them how to put a bandaid on a boo-boo or giving granny CPR. When a first aid course tells me that if the dressing is bleeding through to just place a dressings overtop until you can't see blood soaking through, it tells me that they really dont have a clue what they are doing.
Did you even read my post? If you did you would have seen that I said that the hiring of foreign nationals by US companies, Blackwater, Triple Canopy, was shut down by the State Department (for OpSec reasons), but a few CDN's made it in before that came down. They will hire foreign nationals for non-security positions.
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MG34
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Yes that was in fact sarcasm (can't get nothing past you eh?). Blackwater has never hired foriegn nationals,if you had bothered to read MY post you would have seen that they use other corporations under contract to them.Canadians did and still do (as approved by the US dept of State) train there yes but never have worked directly for BW. Pers in non security positions are PONTIS and do not count anyways.
The simple facts are:
1. There is no current Canadian company that provides TCCS or a similar level of training that is backed up by experience in the field. The current courses are simply rehashes of the original precis created by Frank K Butler (USN) and have not been updated with current experience from the field.
2. Fill out your profile.
Armymedic:
Yes I agree that our medicail system is indeed flawed by years of a clinical mindset,but that does not excuse why the training is not or has not been conducted at a unit level,all it takes is a level of inatative on the part of those on the ground floor.I have talked to several MOs that would be willing to act as medical directors for such a course,yet every day admin and other bullshyte gets in the way. This has to be pushed from the bottom,not from the top. As for the tournquets, CAT is not needed when in house items such as triangular bandages ,a wooden dowel and a 1.5 inch ring will do the job just as well.There is no need for the gucci kit,but it sure as hell makes the job easier. BTW every soldier in the Inf BG will be issued a CAT. A 2 day intro is not exactly the required training but hell we will take waht we can get,although I will be going out of the box on this one and get the training on my own,and will be encouraging my troops to do the same if the system does not supply then we must go out elsewhere and damn the system.
The simple facts are:
1. There is no current Canadian company that provides TCCS or a similar level of training that is backed up by experience in the field. The current courses are simply rehashes of the original precis created by Frank K Butler (USN) and have not been updated with current experience from the field.
2. Fill out your profile.
Armymedic:
Yes I agree that our medicail system is indeed flawed by years of a clinical mindset,but that does not excuse why the training is not or has not been conducted at a unit level,all it takes is a level of inatative on the part of those on the ground floor.I have talked to several MOs that would be willing to act as medical directors for such a course,yet every day admin and other bullshyte gets in the way. This has to be pushed from the bottom,not from the top. As for the tournquets, CAT is not needed when in house items such as triangular bandages ,a wooden dowel and a 1.5 inch ring will do the job just as well.There is no need for the gucci kit,but it sure as hell makes the job easier. BTW every soldier in the Inf BG will be issued a CAT. A 2 day intro is not exactly the required training but hell we will take waht we can get,although I will be going out of the box on this one and get the training on my own,and will be encouraging my troops to do the same if the system does not supply then we must go out elsewhere and damn the system.
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MG34 said:
What do you think we have been doing for the last 5 yrs? How many incentives for change do you have to push up from the bottom before the CO and up get tired of playing "Wack the Mole Sgt". We have been pushing issues from the bottom for years. Unfortunately, we get headaches from all the smashing down we get.
Let give an example. AEDs - IN 1998 Cdn Heart and Stroke recognized AED, particularly a Leaderal version. was the cat's meow. A Sgt presented his case to have AEDs put into all the UMS ambulances and into the unit lines. The CO of 2 CER was so impressed he even offered to pay for 3 out of his unit funds. It was fought all the way up to the Surg Gen....The Sgt was actually told he will cease all efforts and communications in hi effort.
Do you know who was the last people on CFB Petawawa to be legally allowed to use AEDs in their job?.....Medics, we finally have one issued to us this past yr. As a first aider, I could use one in 2003, but not in my role as a med tech until 2005.
How does that pushing from the bottom work for you in the infantry world?
Besides medical people in CFMG HQ do no know what cbt arms need or want for training and skills, and the highers do not believe us lowly med techs when we tell them. But they sure do listen to the CDS.
When you go through the TSMT classes next 2 weeks, let me know how effective my instruction is for your troops before you go off looking. I can guarantee that we military instructors will do it more then sufficient for free then any outside agency will at their exorbitant price. I am one of the two Sgts instructing the CAT and introducing TCCC concepts.
And before we all get wound up about real time experience...how many people have you shot in cbt? About the same number as I have saved in a real tactical scenario. I am sure we will both do our job as best we can when the need arises.
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MG34
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Armymedic said:
Pushing from the bottom is a slow process in the Infantry but it does get results,most of the newer equipment we will have for this tour was the result of several SNCOs pushing for what was needed and not accepting the 'status quo",for example the new OBUA doctrine, the med bags issued to out TCCC pers (no not the inadequate one they were issued),new holsters, and a whole lot more. Simply giving up is not an option when there is a need for equipment or training regardless of how many toes are stepped on.
As for high priced courses I am deploying with 2 qualified paramedics in my Pl,who took the training at their own expense because it was not provided,these are Infanteers who are able to see beyond what the "system" provides and had the will to put their careers on hold to take the next step.If that kind of dedication was shown at all levels then we would not be having this discussion. Time will tell wether or not the 2 day "intro to concepts" course will make the difference when the time comes,I truely hope it does,but if not the possible preventable death of a soldier will be on the hands of those who lacked the vision and foresight to provide the proper training. That being said don't take this as a personal attack,it is the system to blame,at least you can say you did all you could have...or did you?? I know I have been in this and other fights with narrow minded careerists for over 20yrs and plan to continue with it unitl the higher ups start taking notice.
WRT to experience,I'm not going to start telling elaborate war stories here but suffice to say that I have delivered aimed fire on hostile targets at the required time ,and when in my rights to do so under the appliciable ROEs, and also have felt the sting of hostile fire. I've been there and done it,those that know me already know this.
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All good. Today my hackles are not up, and I am in a better mood.
We'll chat when you come over, there will be time betweeen classes etc.
Maybe with your suggestions I'll have more ammo for my push on getting all medics TCCC trained before we try to teach everyone else how to do it (again, cause its too late to stop it now). The basic premis: We are not qualified to do it according to CFMG, because they will not issue me the kit. So how are we qualifed to teach it?
We'll chat when you come over, there will be time betweeen classes etc.
Maybe with your suggestions I'll have more ammo for my push on getting all medics TCCC trained before we try to teach everyone else how to do it (again, cause its too late to stop it now). The basic premis: We are not qualified to do it according to CFMG, because they will not issue me the kit. So how are we qualifed to teach it?
I agree those CP gear packs for TCCC are garbage, mention it when you come over as well.
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I am all for non-medic trades taking medical training.
I remustered from the infantry over to the medical branch as I figured being a medic in the army would jive with what I was taking at school (nursing/paramedicine). From my perspective, and observations of Med-As in the field, it is a lot easier to train someone with a tactical mind paramedicine than to go the other way around. I have seen it time and time again when a medic is attached to a combat unit they just lack the know-how. Take someone from the combat arms train them to be medics.
Now on to the next question: who should do the training? St. John, obviously, is not the way to go but I don't think we should break the bank and pay some ex-SF guy to do the training. If you look at TCCC and Lessons Learned you will see that the vast majority of tactical medicine is basic life support measures for the most part. So, who can teach CF members BLS trauma medicine? Any local EMS training program that has solid ED and EMS clinical time.
I remustered from the infantry over to the medical branch as I figured being a medic in the army would jive with what I was taking at school (nursing/paramedicine). From my perspective, and observations of Med-As in the field, it is a lot easier to train someone with a tactical mind paramedicine than to go the other way around. I have seen it time and time again when a medic is attached to a combat unit they just lack the know-how. Take someone from the combat arms train them to be medics.
Now on to the next question: who should do the training? St. John, obviously, is not the way to go but I don't think we should break the bank and pay some ex-SF guy to do the training. If you look at TCCC and Lessons Learned you will see that the vast majority of tactical medicine is basic life support measures for the most part. So, who can teach CF members BLS trauma medicine? Any local EMS training program that has solid ED and EMS clinical time.
NOOO! You are completely missing the point. The whole point of TCCC is not medical skills. It is how those medical skills are performed in the context of a tactical environment. And a civi paramedic has no clue. And given the skills to a tactical SME, like some infantry guy, doens't mean that they know how to incoporate them into a tactical context. TCCC is filling in the blank. Read the Dispatches again, especially the part that gives a tactical scenario and how the old civi way of approaching would be. It's very dangerous. This is the biggest problem with everybody teaching their own version of TCCC, with no standardization. It is that some people completely miss the point. Just because you are a medic in the Army doesn't make you a TCCC guru, and just because you are an infantry guy with a civi paramedic ticket doesn't make you a TCCC guru. It's the understanding of the stuff in the middle that is so often missed, but is the heart and soul of TCCC. Therefore, I think it is a good idea to hire outside agencies, with experience, as stated in this thread, at the very least, to train the trainers.
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herseyjh said:
The above statement runs counter to the American and British experience. Let's not "reinvent the wheel in the shape of a maple leaf". Tactical Combat Casualty Care is not BTLS but with bullets flying around. I'd like to see you strap an intubated patient to a backboard breathing for him as the troops fight through all around you. Read Capt Frank Butler,USN, treatise on TCCC. He is the founder of modern TCCC concepts. LCdr Butler is a Medical Doctor and a Navy SEAL. There are different levels of TCCC care, all based on proper medical research and medical boards. They pertain to the enviroment, hostile activity, air superiority, level of trg of responder,....ad naseum. It is combat not rocket science. Everyone deployed in the CF must learn TCCC. Medics should be tactically trained to be a greater asset to the Warfighters we serve.
The problem is that the medical corp does not promote a tactical mindset. They assume security will always be there.....there will come a time when the warfighters will be to busy to protect us. On a personal note, I abhor the idea of relying on someone else for my protection. Self-defence is a human right. TCCC concepts are not hard to grasp for anyone who has been on ops. Those that have heard the bells chime believe it to be self evident. The medical corp must move away from this peace time mindset shake the rust off the cogs of military medicine and get to it.
Since most of the medical corp does not think tactically....subcontract out the training to a 'qualified, experienced company'. Certain units in the CF train quite extensively at US facilities and/or bring in instructor from schools to train their people. One unit in Pet recognized a lacking skillset and brought in instructors from the UK to teach their men. They are looking at other options as we speak. It is called 'Alternative Service Delivery'.
It is not expensive as all the R&D, course development, instructor training and ancillary costs are cover by the company delivering the 'product'. It is those above costs that make a mil course development prohibitive. There are other benefits, NCOs will be able to take the course, lead their troops in scenario play and develop a team for deployment. This cannot be done with the NCOs with teaching the troops they have to lead and not getting a chance to learn in a induced stress environment. Making mistakes in training is a learning experience, mistakes in combat means someone dies.
The bottom line is:
1. TCCC is the way to deliver life-saving aid in a active non-permissive environment .
2. Everyone in the CF should be train in TCCC, medics even more so.
3. Find a solution, enact it before people die; Alternative Service Delivery may be the answer.
Check out the following links concepts of care:
http://www.drum.army.mil/sites/tenants/division/CMDGRP/SURGEON/journals/TACTICAL%20COMBAT%20CASUALTY%20CARE.htm
http://www.drum.army.mil/sites/tenants/division/CMDGRP/SURGEON/Ranger%20FR/2%20RFRTCCC.ppt
http://www.au.af.mil/au/awc/awcgate/medical/tacmed-butler.htm
http://www.tricare.osd.mil/conferences/2001/downloads/breakout/T201b_Butler.ppt
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As for the idea of intubating a patient in the middle of a fire fight and then bagging the guy while a firefight rages around you is gung-ho and it would be awesome if that level of training could be achieved, and maintained; however, the reality is this level of ability is not achievable on a large scale. Perhaps TEMS teams in a large urban center might function at that level or perhaps a SF medic, but by definition these are small groups of skilled and motivated people and there is by no means the number of individuals to provide total combat medical care to every forward unit. So who does that leave on the battlefield? A medic who should be skilled at basic life support measures and be switched on tactically. Does this person have to have advanced life support skills? No.
I reviewed you links and I think the material supports this statement. For example CAPT Butler and LTC Hagmann wrote the following:
"Care under Fire"
The care rendered by the RFR/NREMT-B/ Ranger Medic at the scene of the injury, while he and the casualty are still under effective hostile fire.
Available medical equipment is limited to that carried by the individual Ranger or medic in his gear.
"Care under Fire"
No immediate management of the airway should be anticipated at this point because of the need to move the casualty to cover as quickly as possible.
And they are talking about SF ops which by definition should have the best of the best medics.
Now on to the TCCC document:
However, there are no studies that document the ability of inexperienced medical intubationists to accomplish endotracheal intubation on the battlefield. Another major drawback is the use of white-light from the laryngoscope in a hostile environment. One study that examined first-time intubationists trained with manikin intubations alone noted a success rate of only 42% in the ideal confines of the operating room with paralyzed patients.
I hope you see my point here. BLS is the way to go. Get them to a medical facility, surgery, and advanced skills, then from there treat or medevac, and you get them their by stopping bleeding, maybe some IV fluid. These are skills that are live saving and can be maintained without making evryone a ALS provier, 18D, SF medic, ect... And who can do this training? People who have real world trauma experience and who has that? Large trauma systems, so send people there to get up to speed. That is not re-inventing the wheel. We are doing it now. I see army NOs in Vancouver training in the ED to go to Afghanistan. Med-As doing ride alongs with Edmonton EMS. It is the way to go.
I reviewed you links and I think the material supports this statement. For example CAPT Butler and LTC Hagmann wrote the following:
"Care under Fire"
The care rendered by the RFR/NREMT-B/ Ranger Medic at the scene of the injury, while he and the casualty are still under effective hostile fire.
Available medical equipment is limited to that carried by the individual Ranger or medic in his gear.
"Care under Fire"
No immediate management of the airway should be anticipated at this point because of the need to move the casualty to cover as quickly as possible.
And they are talking about SF ops which by definition should have the best of the best medics.
Now on to the TCCC document:
However, there are no studies that document the ability of inexperienced medical intubationists to accomplish endotracheal intubation on the battlefield. Another major drawback is the use of white-light from the laryngoscope in a hostile environment. One study that examined first-time intubationists trained with manikin intubations alone noted a success rate of only 42% in the ideal confines of the operating room with paralyzed patients.
I hope you see my point here. BLS is the way to go. Get them to a medical facility, surgery, and advanced skills, then from there treat or medevac, and you get them their by stopping bleeding, maybe some IV fluid. These are skills that are live saving and can be maintained without making evryone a ALS provier, 18D, SF medic, ect... And who can do this training? People who have real world trauma experience and who has that? Large trauma systems, so send people there to get up to speed. That is not re-inventing the wheel. We are doing it now. I see army NOs in Vancouver training in the ED to go to Afghanistan. Med-As doing ride alongs with Edmonton EMS. It is the way to go.
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starlight,
I agree with everything you say above, except this.
Unless you mean we send out people down or bring people up to/from the US Army/Marine to teach us how to do this first.
I believe bringing in civilian instructors (regardless of the experience) to teach a military course of this context is not "correct" nor fiscally responsible.
I don't think you actually need to be punched in the nose to know it hurts, and accordingly, good knowledge and understanding of the principle of TCCC do not require cbt experience to be able to instruct the concepts to others.
I agree with everything you say above, except this.
starlight_cdn said:
Unless you mean we send out people down or bring people up to/from the US Army/Marine to teach us how to do this first.
I believe bringing in civilian instructors (regardless of the experience) to teach a military course of this context is not "correct" nor fiscally responsible.
I don't think you actually need to be punched in the nose to know it hurts, and accordingly, good knowledge and understanding of the principle of TCCC do not require cbt experience to be able to instruct the concepts to others.
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herseyjh said:
In a military context, that could be 2 things: stupid and suicidal, either way, it'll get you, or worse, the casualty killed. Even a CF PA, who is capable and practiced in the skill of ET intubation would never do it in that context. This way of thinking is exactly why military tactical medicine should be required training for all military med techs. TEMS are civilian paramedics for police. Close but not quite the same thing, because they do not have the restraints of time, distance, enviroment, priority of mission, and the mass of casualties that may face a military medic.
Butler's documents were intially written with SOCOM medics in mind. Now the concepts have been adapted to the basic 91W cbt medic training of the US Army. A 91W is trainied very similar as our QL 3 Med Techs with good basic skills, and the knowledge of where to use them (PHTLS, Paramedic level prehospital care). Difference is that tactical medicine is a large part of thier program, whereas in Canada, it is nowhere to be found outside the brigade's Fd Ambs and a little spot south of Ottawa.
Anyway, this is getting into medic's training. We should be talking about nonmedical persons, and leave the medic tng in the TCCC thread.
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That is my point, it would be crazy, and I was trying to point out that some people do believe that is the skill set that is required for the job when it is not. That is why I will stick by my BLS statement and if non medical pers want to go out and take medical training then by all means it is a good thing. It is good because if you get the BLS, BTLS, TCCC, or what ever you want to call it, message to the troops then they can handle the initial injury and then respond to the tactical situation. They can stop the bleeding, move the wounded to a safe spot, then maybe a CCP and back. From there the medical branch can get involved with the evac. I will just leave it at that so the forum stays on topic.
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aye, I interpreted you were saying something else.
This does not "require" medical skills beyond a few basics, thats why it is so good. It how and when to use the skills you have is what the majority of the concept is all about.
This does not "require" medical skills beyond a few basics, thats why it is so good. It how and when to use the skills you have is what the majority of the concept is all about.
medicineman
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I actually sat down and read the QS today - rather interesting in that the cover sheet has all the MOC's that TCCC is to be an OSQ for. The MOC's listed were all combat arms or combat support - no medical. They did say inside in the working group notes that Medical Branch wanted a seperate course for the Med Techs, but didn't elaborate as to what (perhaps something along the lines of an abbreviated version of the Fleet Marine Force Field Medical School or something along that line).
MTF as things progress.
Armymedic - you catch any of the stuff flying around about the new "Combat Related First Aid" course that's being tossed together in Ottawa. Strange, the power points look awfully like slightly revamped versions of all the courseware from Pet and Edmonton...except they want to condense it to 2 days.
MM
MTF as things progress.
Armymedic - you catch any of the stuff flying around about the new "Combat Related First Aid" course that's being tossed together in Ottawa. Strange, the power points look awfully like slightly revamped versions of all the courseware from Pet and Edmonton...except they want to condense it to 2 days.
MM
