Tactical combat casualty care ( TCCC )

[starlight_745]

My understanding of the CLS in the US is that any medic can teach the course. All the LP's and checklists are available it just requires some initiative at the unit level to get time and stores set aside to run the course.  I also believe it requires around one day per year of refresher training.

 

[Armymedic]

Not any medic can teach CLS, as there is a specific qualification for that, but most above E-5 (straight up Sgt) get it as I recollect (its been 4 yrs since I worked with the yanks). There is material avail on line, try to Google it and see what you get.

I have heard such rumour as well about it being taught in Gagetown (tactics school), and in Borden (CFHSA)....either way its coming out. Personally, it should be taught by the brigade Fd Ambs as that is where the medics and the infantry work the closest.

The TCCC/cbt first responder I teach is more mission specific then what the new courses will be when they come out ot everyone. With the team I will be deploying with, I will be teaching the following skills:

Tactical Assessment,
Airway management and suctioning, NPA
Tourniquet application and removal,
asherman chest seals & chest decompresion

and skills so they can assist me:
C-spine and collar,
initiate (read prime) IV's

 

[medicineman]

The CLS has been a bit of a pet peeve of mine for several years now - ie trying to implement it here.  I have the courseware CD from the US Army - to be an instructor (unless it's changed) you need to be a Senior NCO and an "experienced" CLS.  Instructor is a bit of a misnomer - more like facilitator, becasue alot can be done by distance ed.  I managed to get hold of the CD after much nashing of teeth - took an officer to get it for me (Tech Adj at 2 RCR).  The idea was to try it out with 2RCR - in the end, all the while waiting for some blessings from above, I designed a combat first aid package that seemed to be well received by the unit (they're still using it I mean) - did some real world bleeding control and TK use, rapid surveys and blast/ballistics/burns.  Prior to deploying on Op Athena for the TAT, I did a little IV and morphine famil session as well (hey, my ass could get nailed too).

I couldn't tell how they plan on integrating the TCCC course into the CTC program - it's all still in the word of mouth/pencil stage. Watch and shoot for now.  But, on the bright side, if we're hearing these rumours, the Army wants the training so it's just a matter of when and where it'll be delivered - of course how and by who as well.

MM

 

[Armymedic]

The Army lessons learned center's latest edition of "Dispatches" (Vol 10 no. 2) is about the Tactical Combat Casualty course, written By Cpl Kopp of 3 PPCLI.

It is a good read (as per most ALLC Dispatches) that covers all the good, bad and misunderstood points of current military tactical medicine...even though he is a Infantryman (albiet a civ qual paramedic).

If anyone out there knows Cpl Kopp, pass on a BZ for me.

 

[PRL ER NO]

Can you forward the link for that article.  Sounds like a good read.

Thanks

 

[Fraser.g]

It's not up yet but when it is you will find it at:
http://armyapp.forces.gc.ca/ALLC/Downloads/dispatches.asp?tree=downloads

GF

 

[Navydoc]

Gents-

I came across this chat while at the SOMA meeting 2004.  I represent the USMC on the Committee for TCCC.  I noticed a lot of valid questions about the program and some issues on what is taught.  If I could provide a brief outline, you can fire any questions, concerns, requests my way in the future.

1.  TCCC was born out of the SOF experience in Mogadishu
2.  SOCOM currently endorses TCCC and trains all departing SOF units in TCCC principles.  SOCOM also provides essential supplies.
3.  TCCC is spreading to the USMC and beyond.  TCCC is a mindset, not a rigid set of rules.  It attempts to train medics, corpsmen, and warfighters on how to save lives during the battle.  Obviously, there is more to it.
4.  The Committee on TCCC is composed of trauma surgeons, ER physicians, Delta medics, SOF medics, PJs, and a few good ole Navy docs.  Almost all have seen combat.  All have seen death.  They know their stuff.
5.  TCCC guidelines and ppt presentations can be found on the NOMI (Naval Opeational Medical Institute) website- just google search.
6.  TCCC is being used in Afghanistan and Iraq and is saving lives.

Feel free to contact me for more specifics.  Thanks for the service and thanks for pressing the important issues.

LT David Callaway
Third Radio Battalion
US Marine Forces Pacific

 

[Armymedic]

Sir,
Welcome to the board, any insights and opinions you have are welcome. As we are all a creature of our experience and instruction of others, I look forward to any real time experience you can bring to the site.

 

[medicineman]

I got hold of said powerpoint slides -alot good stuff and some rather intrigung stuff in there too, such as personal non-narcotic analgesia - they have 1G Tylenol with 50mg of Vioxx in a pain pouch as it were - something to get the morphine monkey off our backs for people that can tolerate PO meds.

MM

 

[Fraser.g]

The US troops in theater carry the above mentioned Pain pack along with a broad spectrum antibiotic that they are to take immediately on being injured.

I don't know what a couple of plain Tylenol will do for the pain and now that Vioxx is pulled from the shelf I assume they will be dispensing another anti-inflammatory in its place.

Morphine is still the gold standard for pain control. As long as it is being used in appropriate doses for analgesia there should be no problems with addiction. Where we were hitting the snag is that it was being given IM. Hmmmm Pt loosing blood, going into shock, shunting remaining supply to heart, lungs and brain... away from voluntary muscle...minimal analgesic getting into systemic circulation...Analgesic not effective....given another shot IM.... Pt gets to treatment facility...fluid resuscitation started...blood returns to muscle flushes out all the morphine...Narcan required!

GF

 

[medicineman]

I was rather bemused myself about the Vioxx issue.  I did work with some docs previously who had no greif giving out high doses of Tylenol with or without an NSAID for pain relief.  I still see and read form some medical texts as well that high end NSAID's should be first line for some pain.  A good dose of an NSAID coupled with a high dose of acetaminophen can produce a decent level of analgesia without the narcotic side effects that could inhibit someone who is not terribly injured from putting rounds down range.  The NSAID is also there to try and settle some immuno-inflammatory reactions to trauma.

As for the morphine issue, you're preaching to the choir.  As a pharmacist told me one day - as long as they are in pain, they won't stop breathing on you, so top them up just enough.  You can only do that by IV.

MM

 

[Fraser.g]

With the majority of battle field wounds (80 %) being penetrating I would be hesitant to give anything by mouth as they probably are surgical candidates. The analgesic  aspects of Tylenol are well established and I am not calling it down by any stretch of the imagination however I think it would be the analgesic equivalent of hitting an elephant with a fly swatter. If there is going to be a delay in getting that soldier to care then go for it. The only cautionary thing would be if they are injured in the abd of course. On the side of narcotic effect, if a person is in that much pain to require analgesic they are not going to be in any shape to fight. If you have the time to start an IV or lock then I suspect that the fire fight is over in most cases.
Remember that in battle field aid the first thing you have to do is make the scene safe and that means winning the fire fight. I don't think St Johns had that in mind when they started teaching the scene survey LOL.

As one of the docs said at OP Med..."Remember your ABC's...A Get your ass down, B  Get you butt out of the line of fire, C Circulation (Deadly bleeds only)"



I suspect that they will replace the Vioxx with Baxtra in the near future.

GF

 

[Fraser.g]

It is on line now

GF

 

[MJP]

If anyone out there knows Cpl Kopp,

I was in the same section as him in Bosnia.  He is a SAR tech now.

 

[Infanteer]

Very cool.  The mentality behind this publication is the one we need.  I'll second the BZ.

 

[Armymedic]

The first time I read the credits, I was thinking "what the f#$%? Why is an infanteer writing this?"

Then I thought, if you want to get this message to the masses, its better to use an infantry Cpl, then a trauma surgeon Major.

I ensured every mbr of the team I am going overseas with has a copy. All mbrs want the skill while we are in Afghan. The RCR Major, upon return from tour is going to push for this training for the Bn upon his return.

Too bad it takes people to die to realize what it is we need.

 

[Fraser.g]

here is the link for the PPT for the TCCC course overview.

http://ppt.armystudyguide.com/first-aid/12.htm

There is allot of good stuff on this site.

Merry x-mas

GF

 

[Laps]

I started reading the new Army Lessons Learn - Dispatches today, one that talks about Casualty evacuation.  I really like the fact that the army realizes that the good 'ol standard first aid and CPR from St John Ambulance isn't quite enough.  I hope the airforce (or at least my part of the airforce - the kind that plays with the army quite a lot) gets into it as well.

That booklet talks about the new TCCC course as a pilot program(? meaning of TCCC).  I have not finished reading the whole booklet yet, but I was interested in finding if such a course is offered at large, and what it consists of.

Thanks for any info...

 

[Blakey]

TCCCS "Tactical Command and Control Communications System" I hope I got that in the right order.

 

[PPCLI MCpl]

I believe it is the Tactical Casualty Care Course