Tactical Combat Casualty Care course delivers single standard to SOF medics Published June 20, 2011 By Master Sgt. Donald Sparks U.S. Special Operations Command Europe Public Affairs STUTTGART, Germany -- With more and more European partner nation Special Operation Forces participating in Internal Security Assistance Force operations, having medical personnel available to save the lives of wounded personnel in austere environments is of critical importance. Medical personnel, regardless of nation, must be armed with the appropriate medical equipment and procedures corresponding to each level of care and perform to the same standards. As a result, the U.S. Special Operations Command-Europe developed and conducted a Tactical Combat Casualty Care Train-the-Trainer course to enhance SOF capability and interoperability of participating nations and incorporate one recognized standard for managing trauma on the battlefield. Over a two-week period in May at Zemunik Air Base at Zadar, Croatia, 17 medics from Croatia, Germany, Hungary, Latvia, Lithuania, Romania and Ukraine received expanded medical and trauma care training from U.S. medical personnel from 1st Battalion, 10th Special Forces Group (Airborne) and Air Force Special Operations Command's 352nd Special Operations Group. According to Lt. Col. Mark Ervin, SOCEUR Surgeon, after feedback from several multinational events and deployments that SOCEUR components participated in, it was clear while all participants were familiar with the principles taught as part of TCCC, there were differences in how those principles were applied. "These differing standards led to less effective care when the injured combatant most needed rapid medical treatment," Colonel Ervin said. SOCEUR's goal in organizing the TCCC Train-the-Trainer course was to provide its partner nation SOF medics with knowledge and skills required to instruct others in providing medical care in a combat environment following the guidelines and protocols of TCCC. Although TCCC started as an initiative by U.S. Special Operations Command, it is now used by all services in the U.S. military, conventional as well as SOF communities. It is also used by most allied countries and has been credited as a major factor in U.S. forces having the highest casualty survival rate in our history, according to United States Army Institute of Surgical Research. "This event gave a multinational group of experienced combat trauma care instructors a common course of instruction approved by the official internationally recognized Committee on TCCC," Colonel Ervin said. "This regularly updated and reviewed program can now be used to bring all SOF operators and medics into compliance with an internationally recognized standard." The training objectives of the SOCEUR-sponsored event centered on the three definitive phases of TCCC: Care under Fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic; Tactical Field Care: Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours; and Tactical Evacuation Care: Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase. Training objectives included tourniquet application/hemorrhage control, needle decompression, patient movement/splinting, nasopharyngeal airway insertion, MEDEVAC request/9-Line and rotary wing/loading procedures. Also, the participants had to be able to evaluate each other, design their own scenarios and perform other instructor skills so that they would be able to return their own units able to teach on their own. Colonel Ervin specifically highlighted the importance of having interoperable protocols for tactical field medical care as wounded personnel may likely be treated by medical personnel from a different nation. "With the diverse coalition contributing to ISAF, it is possible that a casualty will be seen by a combat first responder, medic, CASEVAC crew and physician that all come from different countries," Colonel Ervin said. "A standardized protocol of field trauma care, such as TCCC, insures the injured combatant that despite the differences in language, everyone caring for him will be able to perform the most appropriate procedures and communicate using the 'language' of TCCC." As a lead instructor of the event, Master Sgt. Will A. Ward, noncommissioned officer in charge of Medical Operations, 352nd SOG, used his prior TCCC training to bring an air of realism to participants, including "stress inoculation" during the field training exercise (FTX). The concept of "stress inoculation" is derived from a common principle in TCCC: care on the battlefield is almost never under good conditions. Participants were exposed to stressful factors that could influence battlefield casualty care such as enemy fire (the number one factor that determines when and how much care can be provided), darkness, terrain, environmental factors, limited medical equipment, evacuation times and platforms (aerial) based primarily on the tactical situation at the time of the evacuation. They underwent several training lanes in which they were evaluated for their ability to make timely life care decisions under duress. During the FTX, Sergeant Ward's lane focused on rapid patient stabilization while breaking contact, hot landing zone selection, nine-line procedures, and loading and unloading patients from a helicopter. Sergeant Ward highlighted that most battlefield casualty scenarios involve making both medical and tactical decisions very rapidly, so placing the medics in situations where their decisions would be the difference between life and death added to their stress level. "I really wanted to focus on giving the partner nations the same quality and level of training that we get for our initial training," Sergeant Ward said. "This includes the same intensity in the exercises. I remember the first time that I had to perform TCCC guidelines in the dark, in a room simulating aircraft sound, temperature controlled at 105 degrees and with an instructor who was more than happy to 'hurry me along' if I was going too slow. Those lessons helped when I had to perform in theater." As the host of the TCCC course, Maj. Mladen Gavrich, Chief of Medical Department, Croatian Special Operations Forces Battalion, was very impressed with the degree of training the medics underwent. Recognizing that regardless of the subject matter expertise and experience of his own nation's medics had prior to attending the course, Gavrich mentioned the TCCC brought a new dimension to casualty care training that the Croatians had never experienced. "We've never trained like this before, especially placing our medics in stressful conditions," Major Gavrich said. "The training gave our medics a realistic picture of what could go right or wrong when treating a casualty on the battlefield - especially when taking fire with someone's life is depending on them to keep them alive." Major Gavrich stressed the course lays a foundation for future medical training as the Croatians will implement their own TCCC course later this year, "taught with common standards and guidelines of the NATO community." "Long term, this is the first step in the development of an international cadre of TCCC instructors that will provide NATO SOF greater interoperability in field trauma care," Colonel Ervin said. "Ultimately, we expect that the employment of the TCCC standard within NATO (and partner countries) will drive the introduction of the best European combat trauma scientific research into the proceedings of the CoTCCC (committee on TCC)."