Tactical Assesment for Non medical personnel

[Armymedic]

"Any casualty management plan should be considered advisory rather than directive in nature"

You know, if there actually was a plan, an honest workable plan that every soldier knew and practiced each and every exercise, predeployment training, and deployment continuous training, we wouldn't be having this discussion...


And these...

Not to digress from the original thread, but, yes Battle Task Standards covers that:

B-GL-383-002/PT-023 Battle Task Standards - Medical: pg. iii, para 5.

  "These Field Amb BTS emphasize aspects unique to the provision of medical support.   Combat Service Support BTS 1001, " ..."4101" (Defend)   ...   "4316"   (Conduct Road Movement)...."...are of great relevance to Fd Amb operations and should be consulted where a more detailed breakdown of certain tasksis required."

BTS L4316 D/F Conduct Road Movement:   " 6.   i: The packet reacts to air attack or ambush IAW BTS 5004, Defend Against Air Attack or BTS 5006, React to Ambush."

Do not cover it. They are paper guidelines to the unit for training, not workable solutions for the soldiers to practice actual skills.

So are you saying...

What we have and do right now in the CF in regards to when and how we take care of our casualties is sufficient for all situations?

 

[JANES]

We need a flexible guideline, not an SOP, not a drill.  We need to practice TCCC CUF principals, and develope and practice TT&P's WRT casualty recue, so we know how to do them effectively if required.

 

[Armymedic]

Well, I am sure we can keep this arguement going for a while...but I am looking for improvements.

Here is the area of your concern...

Care Under Fire

1. React to fire
  a. seek cover
  b. return fire as trained
  c. attempt to neutralize threat.

2. Contact casualty
  a. direct the casualty to perform self aid
  b. direct the casualty to return fire if able
  c. if casualty is unable to return fire, tell them to lie still

3. Protect casualty from additional wounds
  a. if casualty is able to move direct them to cover
  b. if casualty is unable to move, attempt to recover casualty to safe area

I understand your point of view, but it is not workable, because in point 2, attention is are already being directed towards the casualty vs having all thier attention at the enemy threat.
Possibly adjusting the wording in point 1 would be more realistic, because once the threat is neutalized, then you can carry on to the next stage of care, and the remander of the points are nulified.

1. React to fire
  a. seek cover
  b. return fire as trained
  c. attempt to neutralize threat.

possibly...
d. if contact becomes prolonged then leader to assess need to account for casualties....

or wording to that effect, where it becomes the leaders perogative to take care of casualties sooner then our current doctrine allows.

We need a flexible guideline, not an SOP, not a drill.   We need to practice TCCC CUF principals, and develope and practice TT&P's WRT casualty recue, so we know how to do them effectively if required.

possibly DRILL and SOP are the wrong terms. But JANES is correct, we need a standardized principle that we all know and train with, all the time.

 

[TCBF]

" They are paper guidelines to the unit for training, not workable solutions for the soldiers to practice actual skills."

What? 

The Battle Task Standards are just that - Standards.  They were provided by me in this case because of Snr Med A's concern in his post that:

"  So isn't it reasonable to train as Fd Ambs in convoys that come under attack from the unconventional enemy and throw in the TCCC sops as well?"

So I provided those BTS above in particular to illustrate that Fd Ambs DO have BTS that cover convoys under attack.

As far as "Workable solutions for soldiers to to practice actual skills" goes - BTS are  check lists detailing whether an element has accomplished a series of mandated battle tasks to the standard which the Army demands.  For example, the BTS 6003 B/C/D Treat and Evacuate Casualties is a checklist included in the Infantry BTS. 

If you want to develop a checklist for rapid treatment of cas - whether it becomes an SOP or not - it cannot reduce  element commanders' flexibility to use all of their combat power to fight the engagement as they see fit.  The decision to employ combat power to treat cas must remain a command one, not a medical one.  Here at CMTC, any Medical O/C who attempts to interfere in an assessed combat BTS by attempting to force an element  to deal with cas before possible - from a tactical point of view - would get summed up by the Tactical O/C without much ado.

By all means, develop an SOP, for all of the good reasons listed above, but do not lose site of the mission - state CLEARLY that the decision to employ combat power to treat casualties is the element commander's call, not the SOP's call.

 

[Armymedic]

The argument is pulling away from what I am trying to achieve, but the talk of the BTS did bring me to realize I should look at them myself to ensure that this protocol will fit into them. As it is the BTS which we go back to in training, (regardless of their relevancy in the ever changing world) hence any new standard of training must fit with them.

Possibly it is BTS 6003 B/C/D Treat and Evacuate Casualties, the one of which you speak, that needs to be looked at. 

Here at CMTC, any Medical O/C who attempts to interfere in an assessed combat BTS by attempting to force an element  to deal with cas before possible - from a tactical point of view - would get summed up by the Tactical O/C without much ado.

ah, CMTC...where we still practice fighting the tank battles from the cold war.....

You are absolutely right on that point, and to do that would be a mistake by the Med OC. I think we are talking on different levels, you at Bn, Company and Cbt team, me at section and fire team.

So, if what I have works as a procedure at the lower level, then guidance is needed at the higher level on how best to use it, ensuring that

the decision to employ combat power to treat casualties is the element commander's call

within the parameters of his mission.

 

[JANES]

I think you're trying to re-invent the wheel.  The longer and more complicated the "guideline" becomes the less it is open to flexibility.  The original TCCC CUF guidelines that Butler produced are sufficiently brief yet guiding.  It simply states "Protect the casualty" which covers practically all scenarios.  It does not state perform a rescue, but implies that you "can" or if you can't then the best way to protect him is to continue the fight.  If the fight is just so intense that you cant rescue him, and the medic if fighting for his life, can't get to the casualty - then his firepower is the best medicine, if the casualty exsanguinates before help can arrive, then he is just a casualty of war.  Cést la vie.  Ultimately it is the commander decision, and sometimes it may be a tough decision to make.  Sometimes not rescuing a casualty from a zerod zone will prevent additional casualties - we've all seen Full Metal Jacket!  Should you send a medic to do a rescue?  Do you expose the asset to that increased threat?  Simplicity is best and Butler hit it on the head.  Thats why his guidelines are recognized by the National Association of EMTs (US) and American College of Physicians and Surgeons.

 

[TCBF]

"ah, CMTC...where we still practice fighting the tank battles from the cold war....."

Full Spectrum of Operations (all three blocks at once).  But, that's another thread.

"I think you're trying to re-invent the wheel.  The longer and more complicated the "guideline" becomes the less it is open to flexibility.  The original TCCC CUF guidelines that Butler produced are sufficiently brief yet guiding."

Please show us these here.

However this turns out, kudos to all for discussing it.

 

[Fraser.g]

Here is the Orrigional TCCC evaluation sheet from the US Rangers with changes in wording for Canadian Military Consumers.  

GF

 

[JANES]

Good thing you Canadianized it, I don't speak American.  The Ranger document is an evaluation form for their Ranger First responder course, similiar to combat life saver, or our TCCC pilot.  Here is Capt Butlers TCCC CUF guidelines (you can also find in PHTLS 2003) included here are the official revisions, and are current to date.
1.  Casualty stays engaged as a combatant if appropriate.
2.  Return fire as directed or required.
3.  Try to keep yourself from getting shot.
4.  Try to keep the casualty from sustaining additional wounds.
5.  Airway management is generally best deferred until the Tactical Field Care phase
6.  Stop any life-threatening external hemorrhage:
- Use a tourniquet for extremity hemorrhage
- For non-extremity wounds, apply pressure and/or a HemCon dressing
7. Reassure the casualty

 

[Fraser.g]

Sarcasm noted,

I changed any ref to the Ranger First Responder, also the "GO" "NO GO" as well as changed any Trade names of Medications to the Canadian Equivalent. I am sure that you are conversant with the subtle changes but many reading this thread may not be as conversant as you.

I also note that there is the "Official Ref" to hemcon dressings. I am unaware if they are authorized for use by the CF.

Here is the ref for where the original doc can be found.

GF

http://www.drum.army.mil/sites/tenants/division/CMDGRP/SURGEON/91W%20slide.htm

 

[JANES]

And because I know how much you hate Quickclot:

"The anticipated guidelines will call for HemCon to be used first in situations where hemostatic agents are appropriate and QuikClot to be used as the second option if HemCon is not effective."
- Interview with Captain Frank K. Butler, M.D.
Command Surgeon United States Special Operations Command

 

[Armymedic]

The document you attached is very similar to the protocols I described at the top of the thread.

Once major difference is that the interventions allowed by the CF are far fewer then described in that document. In fact, at this time, Med Tech are not allowed to do IV meds of any type in the field, so it is highly unlikely anyone will be allowing the "uneducated masses" of cbt arms to do those skills. Heck, we are not allowed to teach them how to start IVs.

That doc would be an excellent assessment tool for Med Techs.

Also the document is for TCCC trained Cbt first responders from 10 Mtn Div...

I personally think that program is much better then the commericaly avail PHTLS for our needs, perhaps that could be looked at as well, but that is a discussion for another thread.

 

[JANES]

"Also the document is for TCCC trained Cbt first responders from 10 Mtn Div..."

So tell me then why it states "RFR" as in Ranger First Responder throughout the document.  For only the standard Rangers in the 10 Mtn Div?  What about the other first responders in 10 Mtn Div?  Aren't they allowed? 

 

[Bruce Monkhouse]

Janes,
You are starting to piss me off, these two[ this one and the Tactical Combat Casualty Care Course] medical threads are extremely informative and very reassuring for the personall on the pointy end to know that our medics are as professional as the system allows them to be, and all you can do is sit back with your empty profile and crap on everyone. Well I happen to know a couple of the main posters here and they are nothing but professional.
You, on the other hand, appear to be a whiny internet trashbag, so do us a favour and either state your qualifications and affiliations or hit the road.
This is your warning.
Bruce

 

[old medic]

So tell me then why it states "RFR" as in Ranger First Responder throughout the document.  For only the standard Rangers in the 10 Mtn Div?  What about the other first responders in 10 Mtn Div?  Aren't they allowed? 

Irrelevant.
We are not here to split hairs about word meaning in another military's documents.

Further to Bruce's comments above, this medical forum is visited by numerous medical trades
and professionals of CFMG. They are here for professional discussion or to assist in answering
questions. They do not come here for the sarcasm or goofy comments.