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Who will be eligible to teach this course? Does anyone have links to the training plans and how do we get it up and running in our area?
Tactical combat casualty care ( TCCC )
- Thread starter starlight_745
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LFWA. I haven't taken the course but I'd love too. As far as I know there was one pilot course run by 1 CMBG other than that I'm not sure.
Y
Yard Ape
Guest
I'm interested to hear what is taught on this course. Can soemone break it down by PO?
MedCorps
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Unfortunately at this time there is not standardized course. I have seen presented in two ways.
The first way is for medical personnel as part of a larger course that deals with Combat Casualty Care in general (just not tactical combat casualty care). When I first took it, I did it this way as part of the Combat Casualty Care Course run by the Defense Medical Readiness Training Institute in Fort Sam Houston. I have also seen it run by the UK RAMC as part of the Battlefield Advanced Trauma Life Support Course. We have run it in Canada as part of larger OP ATHENA medical pers work-up training for ROTO 0 and ROTO 0A (Medical Augmentation). We also ran it as part of a clinical training week called "Combat Medicine 2004".
The second way is for the warfighter, whom it really is intended for. It was run as a 1 or 2 day course. If I had to put PO's to it... it would look like this.
PO 001 - The Casualty Treatment and Evacuation Process (CUF vs TFC vs CCEC)
PO 002 - How Casualties Die (the big 3 and Tri-model death distribution)
PO 003 - Care Under Fire
PO 004 - Airway Problems and Management (with Lab [open airway, bulb suction, NPA, OPA])
P0 005 - Tension and Open Pnumothorax and Management (with Lab [needle decompression and Chest
sealing techniques x2])
PO 006 - Stop Bleeding and Treat Shock (with lab [shell dressing and one handed tourniquet, and improv.
tourniquet])
PO 007 - Triage
PO 008 - Morphine Autoinjectors (if issued)
PO 010 - Scenario Based Training (Exercise)
Here is more information:
http://www.google.ca/search?q=cache:X5nV_O9BVUAJ:www.nomi.med.navy.mil/Text/Tactical%2520Combat%2520Casualty%2520Care%2520Guidelines.pdf+%22Tactical+Combat+Casualty+Care%22&hl=en&ie=UTF-8
I suspect sooner or later that it will be standardized for the CF in a course. It is the waiting game, as mentioned in another thread. It is good to hear that 1 CMBG ran a course.
Cheers,
MC
The first way is for medical personnel as part of a larger course that deals with Combat Casualty Care in general (just not tactical combat casualty care). When I first took it, I did it this way as part of the Combat Casualty Care Course run by the Defense Medical Readiness Training Institute in Fort Sam Houston. I have also seen it run by the UK RAMC as part of the Battlefield Advanced Trauma Life Support Course. We have run it in Canada as part of larger OP ATHENA medical pers work-up training for ROTO 0 and ROTO 0A (Medical Augmentation). We also ran it as part of a clinical training week called "Combat Medicine 2004".
The second way is for the warfighter, whom it really is intended for. It was run as a 1 or 2 day course. If I had to put PO's to it... it would look like this.
PO 001 - The Casualty Treatment and Evacuation Process (CUF vs TFC vs CCEC)
PO 002 - How Casualties Die (the big 3 and Tri-model death distribution)
PO 003 - Care Under Fire
PO 004 - Airway Problems and Management (with Lab [open airway, bulb suction, NPA, OPA])
P0 005 - Tension and Open Pnumothorax and Management (with Lab [needle decompression and Chest
sealing techniques x2])
PO 006 - Stop Bleeding and Treat Shock (with lab [shell dressing and one handed tourniquet, and improv.
tourniquet])
PO 007 - Triage
PO 008 - Morphine Autoinjectors (if issued)
PO 010 - Scenario Based Training (Exercise)
Here is more information:
http://www.google.ca/search?q=cache:X5nV_O9BVUAJ:www.nomi.med.navy.mil/Text/Tactical%2520Combat%2520Casualty%2520Care%2520Guidelines.pdf+%22Tactical+Combat+Casualty+Care%22&hl=en&ie=UTF-8
I suspect sooner or later that it will be standardized for the CF in a course. It is the waiting game, as mentioned in another thread. It is good to hear that 1 CMBG ran a course.
Cheers,
MC
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The US 91W web page had a link to a very long (150+) powerpoint presentation that seems to sum up the TCCC (see link in this thread for the ppt) . The program is also supposed to be covered in the latest edition of Prehospital Emergency Care and Crisis Intervention, but I haven't seen it yet.
It is a standardized course, in that a syllabus has been approved by the American College of Surgeons, so if you're going to call it the TCCC, it probably needs to be run along their syllabus. I haven't heard of it being offered anywhere outside of the military, but I suspect some of the ATLS chapters would have the resources and expertise to run an excellent one.
DF
Addendum:
here's the link to the actual powerpoint, fromt he US Army 91W site:
http://www.cs.amedd.army.mil/91w/index.html
As well, thinking of the training of non-medical people in this as a standard of care, it would need to be divided into an advanced and basic provider course. While IV initiation, needle decompression, and crychoidthyrotomy are all very good procedures to have available, the possible complications, especially on the battlefield, are catastrophic. WRT Needle cothoracocentesis, go to trauma.org and read the archived discussion by thoracic surgeons as to the efficacy and usefullness of prehospital decompression by paramedics and EMT's, much less Combat Life Savers
It is a standardized course, in that a syllabus has been approved by the American College of Surgeons, so if you're going to call it the TCCC, it probably needs to be run along their syllabus. I haven't heard of it being offered anywhere outside of the military, but I suspect some of the ATLS chapters would have the resources and expertise to run an excellent one.
DF
Addendum:
here's the link to the actual powerpoint, fromt he US Army 91W site:
http://www.cs.amedd.army.mil/91w/index.html
As well, thinking of the training of non-medical people in this as a standard of care, it would need to be divided into an advanced and basic provider course. While IV initiation, needle decompression, and crychoidthyrotomy are all very good procedures to have available, the possible complications, especially on the battlefield, are catastrophic. WRT Needle cothoracocentesis, go to trauma.org and read the archived discussion by thoracic surgeons as to the efficacy and usefullness of prehospital decompression by paramedics and EMT's, much less Combat Life Savers
MedCorps
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The non-Med Tech TCCC Crses did not include IVs nor crics. The MO(s) running the program did not feel that you could teach, with any confidence or real practice a non clinician how to do a cric. It is a complex procedure... we opted for the, head tilt chin lift, NPA / OPA instruction in lieu of cric.
IVs again. In the early / mid 1990 we opted to start teaching warfighter how to do IVs. It turned out that while some of them could gain ability in the classroom, in almost none of the "real life" (then Bosnia) situations where IVs attempted to be started could they get it. Lets face it, someone in hypovolemic shock who may be already dehydrated to start with is hard to get a IV on. There were other issues...
1) "Well, if we cannot get it into the vein we will sent it per rectum like the Brits did in the Falklands" (2 attempts then go rectal). DCIEM did a study (with UofT) and it turned out that fluid really could not be absorbed at any useful rate to be helpful to the shocky casualty. Bad idea.
2) "Gee... IV solution is heavy... maybe I don't want to carry a 1L (=1 kg) bag round in my asspack / tac vest".
3) How much of a 1 L bag of Lactated Ringers stays in the vascular space after 1 hour of being dumped in? Around 300 mL worth. In order to replace real losses (even for hypovolemic resus), you really need to put in more than one or two bags (especially in a long evac). The real answer would be to go to Pentaspan or the like. We are not quite there yet (did you know a 500 cc bag of Pentaspan is like $600.00 cdn?). A month or so ago DCIEM ran a really good conference on fluid resuscitation in combat. Neat stuff. They are still hard at work on an artificial blood expander. When that happens we have had a revolution in battlefield medicine.
4) What is the best treatment for hypovolemic shock? Stop the bleeding. Quick. Thus the one handed tourniquet being procured and taught. We also taught improvised tourniquets too.
Needle decompression is taught. Pneumothorax is the #2 killer of the preventable combat deaths (21%). Needs to be treated quick, quick especially if it of any real size. It is felt that you can teach a non-clinician to recognize (and then test them with SimMan / METI) a tension pneumothorax. I would rather they decompress someone (with proper technique) who did not need it than miss someone who needed it. We can deal with someone a few hours down the road who has a 14 ga angiocath in their chest and an Asherman Chest Seal over it, much easier than treating someone a few hours down the road who has had a massive pneumothorax.
Cheers,
MC
IVs again. In the early / mid 1990 we opted to start teaching warfighter how to do IVs. It turned out that while some of them could gain ability in the classroom, in almost none of the "real life" (then Bosnia) situations where IVs attempted to be started could they get it. Lets face it, someone in hypovolemic shock who may be already dehydrated to start with is hard to get a IV on. There were other issues...
1) "Well, if we cannot get it into the vein we will sent it per rectum like the Brits did in the Falklands" (2 attempts then go rectal). DCIEM did a study (with UofT) and it turned out that fluid really could not be absorbed at any useful rate to be helpful to the shocky casualty. Bad idea.
2) "Gee... IV solution is heavy... maybe I don't want to carry a 1L (=1 kg) bag round in my asspack / tac vest".
3) How much of a 1 L bag of Lactated Ringers stays in the vascular space after 1 hour of being dumped in? Around 300 mL worth. In order to replace real losses (even for hypovolemic resus), you really need to put in more than one or two bags (especially in a long evac). The real answer would be to go to Pentaspan or the like. We are not quite there yet (did you know a 500 cc bag of Pentaspan is like $600.00 cdn?). A month or so ago DCIEM ran a really good conference on fluid resuscitation in combat. Neat stuff. They are still hard at work on an artificial blood expander. When that happens we have had a revolution in battlefield medicine.
4) What is the best treatment for hypovolemic shock? Stop the bleeding. Quick. Thus the one handed tourniquet being procured and taught. We also taught improvised tourniquets too.
Needle decompression is taught. Pneumothorax is the #2 killer of the preventable combat deaths (21%). Needs to be treated quick, quick especially if it of any real size. It is felt that you can teach a non-clinician to recognize (and then test them with SimMan / METI) a tension pneumothorax. I would rather they decompress someone (with proper technique) who did not need it than miss someone who needed it. We can deal with someone a few hours down the road who has a 14 ga angiocath in their chest and an Asherman Chest Seal over it, much easier than treating someone a few hours down the road who has had a massive pneumothorax.
Cheers,
MC
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Med Corps,
Great info in your post above. I heartily agree with your above post. I attended some con ed in my civi job last year where a trauma surgeon was talking about the vicious triad of hemodilution, coagulopathy, and hypothermia in regards to zealous fluid resuscitation. Made for some interesting thinking. We cannot over emphasize the importance of doing the basics properly and quickly. Do you know if there is any trialing of things like the chitosan/fibrin impregnated bandages nad/or quickclot? What we really need is a well stocked and useful individual and section level first aid kit for the troops to use and then give them the training on how to use it properly.
Great info in your post above. I heartily agree with your above post. I attended some con ed in my civi job last year where a trauma surgeon was talking about the vicious triad of hemodilution, coagulopathy, and hypothermia in regards to zealous fluid resuscitation. Made for some interesting thinking. We cannot over emphasize the importance of doing the basics properly and quickly. Do you know if there is any trialing of things like the chitosan/fibrin impregnated bandages nad/or quickclot? What we really need is a well stocked and useful individual and section level first aid kit for the troops to use and then give them the training on how to use it properly.
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I agree, judging from the presentation, entirely about the fluid resuscitation and airway management, and the need for a CLS-type course for our cbt arms team, but I still have reservations about the over-zealous application of 14g angiocaths to chest walls.
Most 14g needles ( and the standard CF one) are too short to penetrate the parietal pleura, anyway, 2" or 5cm is needed, and most are 1 1/4 to 1 1/2" long.
I'd again recommend reading the 5yr+ debate on decompression on the trauma archives discussion group. An interesting section on permissive hypotension, too.
Doug
Most 14g needles ( and the standard CF one) are too short to penetrate the parietal pleura, anyway, 2" or 5cm is needed, and most are 1 1/4 to 1 1/2" long.
I'd again recommend reading the 5yr+ debate on decompression on the trauma archives discussion group. An interesting section on permissive hypotension, too.
Doug
MedCorps
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A few thoughts....
Section medical kit. For OP ATHENA Roto 0 we issued the following "leg bag"" medical kit to the sections with a "CF TCCC Crse".
CPR Mask x 1
NPA x 1 set
Small KY Jelly for NPA x 6 pk
OPA x 2
Bulb suction x 1
Asherman chest seals x 2
Alcohol Swabs x 4
14 ga angiocatheters x 2
Tourniquets x 2
Field dressing x 2
Triangular bandages x 2
OpSite x 2
EMT Sissors x 2
Latex Gloves x 2 pr
Roll of tape x 1
Skin marker x 1
Because 3 RCR is keen, they took First Aid prep quite seriously, and upped the holding of medical supplies in in the tac vest and in all vehicles, purchased lightweight folding stretchers for troops to carry in the rucksack.
14 ga Angiocath... yep 2" is what you need. That is what is in the kit. They are in the CAMMS (CMED) catalog for order. I am not sure if they are matched to a SMN yet, but if they are not I can get that done easy enough for everyone. The UK have a piece of kit I am quite smitten with. When I worked with them, it is what was issued to all of the RMAs and CMTs for needle decompression. It is by Tyco Health Care and called the Kendall Meicut Intravenous Cannula (p/n 8888-100206). It is a 12 ga, 2" sheathed needle attached on a 2.5 cc syringe. The whole thing comes in a hard plastic container, which survives much better in a jump bag than the normal angio-cath package. Good for needle decompression. I could not link the page, but if you go here:
http://www.kendallhq.com/catalog/searchtype.asp
and type Medicut in the word search you will return the ARGYLE MEDICUT Intravenous Cannulas. Click this and ou have a picture.
Clotting Dressings. When I was with the Americans on the Comabt Casualty Care Course in Texas they spoke about the Quik-Clot dressing they were using in Iraq (http://www.z-medica.com/). They were having some problems with it at the time (the biggest problem being that the pouch contained a powder to place on the wound [like old Sulpha powder] before putting the dressing on. In people with heavy bleeding, in the panic, the soldier would pour the powder on the bleeding wound. By the time then opened the dressing an placed it on the wound, all of the clotting powder was washed away by the bleeding before it could work.
Then came the bad news message.... Quick Clot creates an exothermic reaction in the clotting process bringing the wound temperature up to 100 + degrees. Oh... that is not good. Stop using it, the message came out. If you want to see the message let me know. It is at work, and I need to send it to my home account.
Here is some talk about it though... interesting read. The USASOC message they talk about is the one I have:
http://www.warriortalk.com/showthread.php?t=1183&page=1&pp=10
I am not sure what the status of the product is. Pre OP ATHENA Roto 0 CFMGHQ / G4 was not comfortable with going with the quick-clot dressing. Thus we opted for the 2 normals field dressings in the kit vice the planned 2 x Quick-clot. Looking at the z-medica website it looks like they may have sorted things out.... then again these are the people who make it, so can you really trust them?
The US DoD and the CF are working on new clotting dressings. We will see them in out lifetime I am sure. Another tool. The other product the US Army was looking at was the Chitosan Hemostatic Dressing (Hemcon?). Here is some information on it:
http://www.dcmilitary.com/army/standard/8_04/national_news/21677-1.html
At the time they were more impressed with the QuikClot, but I am not sure what the deal is.
Cheers,
MC
Section medical kit. For OP ATHENA Roto 0 we issued the following "leg bag"" medical kit to the sections with a "CF TCCC Crse".
CPR Mask x 1
NPA x 1 set
Small KY Jelly for NPA x 6 pk
OPA x 2
Bulb suction x 1
Asherman chest seals x 2
Alcohol Swabs x 4
14 ga angiocatheters x 2
Tourniquets x 2
Field dressing x 2
Triangular bandages x 2
OpSite x 2
EMT Sissors x 2
Latex Gloves x 2 pr
Roll of tape x 1
Skin marker x 1
Because 3 RCR is keen, they took First Aid prep quite seriously, and upped the holding of medical supplies in in the tac vest and in all vehicles, purchased lightweight folding stretchers for troops to carry in the rucksack.
14 ga Angiocath... yep 2" is what you need. That is what is in the kit. They are in the CAMMS (CMED) catalog for order. I am not sure if they are matched to a SMN yet, but if they are not I can get that done easy enough for everyone. The UK have a piece of kit I am quite smitten with. When I worked with them, it is what was issued to all of the RMAs and CMTs for needle decompression. It is by Tyco Health Care and called the Kendall Meicut Intravenous Cannula (p/n 8888-100206). It is a 12 ga, 2" sheathed needle attached on a 2.5 cc syringe. The whole thing comes in a hard plastic container, which survives much better in a jump bag than the normal angio-cath package. Good for needle decompression. I could not link the page, but if you go here:
http://www.kendallhq.com/catalog/searchtype.asp
and type Medicut in the word search you will return the ARGYLE MEDICUT Intravenous Cannulas. Click this and ou have a picture.
Clotting Dressings. When I was with the Americans on the Comabt Casualty Care Course in Texas they spoke about the Quik-Clot dressing they were using in Iraq (http://www.z-medica.com/). They were having some problems with it at the time (the biggest problem being that the pouch contained a powder to place on the wound [like old Sulpha powder] before putting the dressing on. In people with heavy bleeding, in the panic, the soldier would pour the powder on the bleeding wound. By the time then opened the dressing an placed it on the wound, all of the clotting powder was washed away by the bleeding before it could work.
Then came the bad news message.... Quick Clot creates an exothermic reaction in the clotting process bringing the wound temperature up to 100 + degrees. Oh... that is not good. Stop using it, the message came out. If you want to see the message let me know. It is at work, and I need to send it to my home account.
Here is some talk about it though... interesting read. The USASOC message they talk about is the one I have:
http://www.warriortalk.com/showthread.php?t=1183&page=1&pp=10
I am not sure what the status of the product is. Pre OP ATHENA Roto 0 CFMGHQ / G4 was not comfortable with going with the quick-clot dressing. Thus we opted for the 2 normals field dressings in the kit vice the planned 2 x Quick-clot. Looking at the z-medica website it looks like they may have sorted things out.... then again these are the people who make it, so can you really trust them?
The US DoD and the CF are working on new clotting dressings. We will see them in out lifetime I am sure. Another tool. The other product the US Army was looking at was the Chitosan Hemostatic Dressing (Hemcon?). Here is some information on it:
http://www.dcmilitary.com/army/standard/8_04/national_news/21677-1.html
At the time they were more impressed with the QuikClot, but I am not sure what the deal is.
Cheers,
MC
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Good to hear that the CF has the longer angiocaths in the system now, and, again, I agree about the British 12g caths, I managed to scoop 3 or 4 while in the UK with 75 ER, great "jump-bag friendly" packaging (speaking of which, most of their kit is much better packaged then ours). I'd heard about the exothermic problem with the clotting dressings, kinda funny, isn't the center of a burn the "zone of coagulation" ? what are we trying to achieve anyway? ;D
Army Lesson Learned Center put out a suggested list of the section medical kits from one of the Roto to Bosnia, again I seem to recall it being an RCR initiative. Seemed to be a good idea, lots of dressings, little bit of fluids, good for a well trained First Responder with IV potential.
Folding strethers, great idea. I like the SKED, used it a couple of times, but it's very bulky to pack around, even if it does give you that golfing LCF. I've never used the Talon or Talon II, any comments on them out there?
NPA/OPA, sure, whatever holds the tongue out of the way. Bulb suction is of limited value, but better then nothing. There's a new product out that combines a reservoir bag with a "turkey baster" style suction, same size benfits of the bulb with a capacity that probably exceeds a Res-Q-Vac, which puts the V-Vac to shame.
Speaking of the RAMC CMT's they don't seem to have the same concerns on CME or MCSP that we have, it would be interesting to see how they've worked out on deployment. I also really admired their Patient Care Regimes, which set out "standard" treatments, including abx and analgesics, at various level of evac.
Doug
Army Lesson Learned Center put out a suggested list of the section medical kits from one of the Roto to Bosnia, again I seem to recall it being an RCR initiative. Seemed to be a good idea, lots of dressings, little bit of fluids, good for a well trained First Responder with IV potential.
Folding strethers, great idea. I like the SKED, used it a couple of times, but it's very bulky to pack around, even if it does give you that golfing LCF. I've never used the Talon or Talon II, any comments on them out there?
NPA/OPA, sure, whatever holds the tongue out of the way. Bulb suction is of limited value, but better then nothing. There's a new product out that combines a reservoir bag with a "turkey baster" style suction, same size benfits of the bulb with a capacity that probably exceeds a Res-Q-Vac, which puts the V-Vac to shame.
Speaking of the RAMC CMT's they don't seem to have the same concerns on CME or MCSP that we have, it would be interesting to see how they've worked out on deployment. I also really admired their Patient Care Regimes, which set out "standard" treatments, including abx and analgesics, at various level of evac.
Doug
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I have used the talon folding litters berfore and they are great. Fold out and look very similar to our regular litters but just fold up into a nice compact package for storage. There are also poleless litters out there than are nylon and can be basically rolled up and stashed in a pack, ideal for an infantry section.
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I instructed on the course that was taught to 3 RCR prior to going to OP Athena. The Doctor who rammed it thru the planning was in contact with the team from LFWA who organized the courses out there. These courses have been reconized as filling a gap within the military between the normal first aid training, and what we need in the true basic combat lifesaving skills. Med Corps already talked about some of the course content and kit used...
Coming shortly is a confrence about the course in Edmonton, and CFHS discussion on course content and to whom the course/skills should be taught. IMO it should be taught to 1 in 10 cbt arms pers, 1 in 20 CSS and all QL 3 med techs on completion of thier PCP course to give them a military knowledge base they all currently lack.
As for instructors, It wasn't a stretch for the experienced BTLS instructors on the above course to teach, as it is still good basic medicine taught with a diffrent mind set.
So we should hear more about in the Reg forces circles in the next couple months...
Coming shortly is a confrence about the course in Edmonton, and CFHS discussion on course content and to whom the course/skills should be taught. IMO it should be taught to 1 in 10 cbt arms pers, 1 in 20 CSS and all QL 3 med techs on completion of thier PCP course to give them a military knowledge base they all currently lack.
As for instructors, It wasn't a stretch for the experienced BTLS instructors on the above course to teach, as it is still good basic medicine taught with a diffrent mind set.
So we should hear more about in the Reg forces circles in the next couple months...
MedCorps
Sr. Member
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SPECOPS IDC HM 8491/HM 8403 JSOMTC: USE OF THE HEMOSTASIS PRODUCT QUIKCLOT MADE BY Z-MEDICA
1. UNTIL FURTHER NOTICE ALL USSOCOM PERSONNEL ARE PROHIBITED FROM
USING THE HEMOSTASIS PRODUCT QUIKCLOT (TM) MADE BY Z-MEDICA.
2. QUIKCLOT (TM) IS A COMMERCIAL OFF-THE-SHELF PRODUCT WITH FDA
APPROVAL FOR EXTERNAL USE TO ACHIEVE HEMOSTASIS (CONTROL
HEMORRHAGE). THIS PRODUCT WAS PURCHASED IN QUANTITY BY THE ARMY AND
USMC MEDICAL AGENCIES BECAUSE OF THE EARLY FDA APPROVAL AND THE
BLOOD CLOTTING POTENTIAL OF THE PRODUCT. SMALL QUANTITIES OF THE
QUIKCLOT (TM) HAVE FOUND THEIR WAY TO USSOCOM MEDICS THROUGH
SERVICE CONTACTS AND DIRECT FROM THE VENDOR FOR THE SAME REASON
SERVICES ORIGINALLY PROCURED THE PRODUCT
3. WHEN QUIKCLOT (TM) GRANULES ARE POURED INTO A HEMORRHAGING WOUND
A REACTION BEGINS HEATING THE BLOOD TO TEMPERATURES FROM 90-100
DEGREE CENTIGRADE (194-212 DEGREE FAHRENHEIT). THIS TEMPERATURE
COAGULATES (CLOTS) THE BLOOD, BUT ALSO HEATS LOCAL SKIN, MUSCLE,
AND NERVE TISSUE TO BOILING TEMPERATURES.
4. ARMY AND AIR FORCE MEDICAL RESEARCH LABS HAVE REVIEWED QUIKCLOT
(TM) AND RECOMMEND NOT USING THE PRODUCT.
5. UNTIL APPROVAL BY SERVICE MEDICAL RESEARCH LABS, DEVELOPMENT OF
POST USE PROCEDURES, AND CONCURRENCE OF USSOCOM COMMAND SURGEON;
QUIKCLOT (TM) IS PROHIBITED FROM USE BY USSOCOM PERSONNEL.
6. POC IS LT COL J. R. LORRAINE, USSOCOM:SOCS-SG, DSN
299-5051/5442. Submitted by: HMCM Gary E. Welt, USN SEA, JSOMTC,
FT. Bragg, NC Comm: (910) 396 - 0089 Ext. 145 DSN: 236 Fax: 396 -5395
----------------------------------------------------------
Field Report Marine Corps Systems Command Liaison Team
Central Iraq 20 April to 25 April 2003
QuikClot by Z-Medica ~ 2D Tank Battalion Surgeon LT Bruce Webb
(USN) stated that Quik-Clot was ineffective (specifically, it was
ineffective on arterial bleeding). Battalion Corpsman attempted to
use Quik- Clot in three separate occasions:
Wounded Iraqi civilian. Shot near brachial artery. Quik Clot was
applied >per the instructions. The substance dried but was
flaking off. Standard direct pressure applied by corpsman proved
more effective on the patient.
Iraqi civilian shot in back with punctured spine. Quik-Clot
applied to severe bleeding. Pressure from bleeding sprayed
Quik-Clot away. According to LT Webb, "Quik-Clot was everywhere
but the wound".
Iraqi civilian, female, shot in femoral artery. She suffered
severe arterial bleeding. Patient bled out. Quik-clot unable to be
applied effectively due to pressure of blood >flow from wound.
Patient died.
An LAR Marine was shot in the femoral artery. Quick Clot was
applied to >the heavily bleeding wound. The pressure from the
blood soon caused the quick clot to be pushed >out of the wound and
rendered ineffective. A tourniquet was applied instead. The patient
died. Quik Clot may work if applied in a "buddy system" manner. One
individual applies the Quik Clot substance while another individual
quickly applies the sterile gauze to the wound. However, applying
the Quik-Clot as directed proved ineffective. Direct pressure and
tourniquets were used instead. (note: different opinion from the
MEU MO interviewed. Recommend further study on this item).
Cheers,
MC
1. UNTIL FURTHER NOTICE ALL USSOCOM PERSONNEL ARE PROHIBITED FROM
USING THE HEMOSTASIS PRODUCT QUIKCLOT (TM) MADE BY Z-MEDICA.
2. QUIKCLOT (TM) IS A COMMERCIAL OFF-THE-SHELF PRODUCT WITH FDA
APPROVAL FOR EXTERNAL USE TO ACHIEVE HEMOSTASIS (CONTROL
HEMORRHAGE). THIS PRODUCT WAS PURCHASED IN QUANTITY BY THE ARMY AND
USMC MEDICAL AGENCIES BECAUSE OF THE EARLY FDA APPROVAL AND THE
BLOOD CLOTTING POTENTIAL OF THE PRODUCT. SMALL QUANTITIES OF THE
QUIKCLOT (TM) HAVE FOUND THEIR WAY TO USSOCOM MEDICS THROUGH
SERVICE CONTACTS AND DIRECT FROM THE VENDOR FOR THE SAME REASON
SERVICES ORIGINALLY PROCURED THE PRODUCT
3. WHEN QUIKCLOT (TM) GRANULES ARE POURED INTO A HEMORRHAGING WOUND
A REACTION BEGINS HEATING THE BLOOD TO TEMPERATURES FROM 90-100
DEGREE CENTIGRADE (194-212 DEGREE FAHRENHEIT). THIS TEMPERATURE
COAGULATES (CLOTS) THE BLOOD, BUT ALSO HEATS LOCAL SKIN, MUSCLE,
AND NERVE TISSUE TO BOILING TEMPERATURES.
4. ARMY AND AIR FORCE MEDICAL RESEARCH LABS HAVE REVIEWED QUIKCLOT
(TM) AND RECOMMEND NOT USING THE PRODUCT.
5. UNTIL APPROVAL BY SERVICE MEDICAL RESEARCH LABS, DEVELOPMENT OF
POST USE PROCEDURES, AND CONCURRENCE OF USSOCOM COMMAND SURGEON;
QUIKCLOT (TM) IS PROHIBITED FROM USE BY USSOCOM PERSONNEL.
6. POC IS LT COL J. R. LORRAINE, USSOCOM:SOCS-SG, DSN
299-5051/5442. Submitted by: HMCM Gary E. Welt, USN SEA, JSOMTC,
FT. Bragg, NC Comm: (910) 396 - 0089 Ext. 145 DSN: 236 Fax: 396 -5395
----------------------------------------------------------
Field Report Marine Corps Systems Command Liaison Team
Central Iraq 20 April to 25 April 2003
QuikClot by Z-Medica ~ 2D Tank Battalion Surgeon LT Bruce Webb
(USN) stated that Quik-Clot was ineffective (specifically, it was
ineffective on arterial bleeding). Battalion Corpsman attempted to
use Quik- Clot in three separate occasions:
Wounded Iraqi civilian. Shot near brachial artery. Quik Clot was
applied >per the instructions. The substance dried but was
flaking off. Standard direct pressure applied by corpsman proved
more effective on the patient.
Iraqi civilian shot in back with punctured spine. Quik-Clot
applied to severe bleeding. Pressure from bleeding sprayed
Quik-Clot away. According to LT Webb, "Quik-Clot was everywhere
but the wound".
Iraqi civilian, female, shot in femoral artery. She suffered
severe arterial bleeding. Patient bled out. Quik-clot unable to be
applied effectively due to pressure of blood >flow from wound.
Patient died.
An LAR Marine was shot in the femoral artery. Quick Clot was
applied to >the heavily bleeding wound. The pressure from the
blood soon caused the quick clot to be pushed >out of the wound and
rendered ineffective. A tourniquet was applied instead. The patient
died. Quik Clot may work if applied in a "buddy system" manner. One
individual applies the Quik Clot substance while another individual
quickly applies the sterile gauze to the wound. However, applying
the Quik-Clot as directed proved ineffective. Direct pressure and
tourniquets were used instead. (note: different opinion from the
MEU MO interviewed. Recommend further study on this item).
Cheers,
MC
MedCorps
Sr. Member
- Reaction score
- 86
- Points
- 330
The company markets it to "speed coagulation of blood, even in large wound", and for "Traumatic Bleeding". They make no direct claim (that I am aware of) about in being used for the control of bleeding from an artery.
That being said in real life medicine traumatic bleeding, does not exclude arterial bleeds, in fact "good trauma (tm)" often has the person pouring out blood from a arterial bleed. Large wounds also are more likely to have an arterial bleed (location on body dependant)....
With all the hype of this product (from both z-medica, and the US DoD) orginally, you would guess that it would stop any bleeding, drive the amublance and bill the casualty on it's own. <smile>.
Cheers,
MC
That being said in real life medicine traumatic bleeding, does not exclude arterial bleeds, in fact "good trauma (tm)" often has the person pouring out blood from a arterial bleed. Large wounds also are more likely to have an arterial bleed (location on body dependant)....
With all the hype of this product (from both z-medica, and the US DoD) orginally, you would guess that it would stop any bleeding, drive the amublance and bill the casualty on it's own. <smile>.
Cheers,
MC
- Reaction score
- 0
- Points
- 60
I agree with Armymedic. After working EMS for several years in a major Canadian city and attending numerous beatings/shootings/stabbings, I have yet to see life threatening bleeding that could not be controlled by direct pressure, pressure points, tourniquets or a combination of the previous (not including internal bleeding of course). I would be very leary of anything causing an exothermic reaction as well. Also how difficult is it to get this stuff out of a wound? Are there any surgeons here with experience removing this stuff from a gaping wound? We can never emphasize the basics enough. I think armymedics earlier post about applying good basic medicine in a hostile environment is bang on and should really guide our training at all levels.
- Reaction score
- 1
- Points
- 230
Here is a list from the Interim TP of the CF TCCC
PO 401 Tactical Combat Casuality Care Concept
401.01 Intoduction/Legal Considerations
401.02 Review of TCCC/Crse Objectives
401.03 TCCC Part 1,2,3
401.04 Scenario Homework (Presentations and Discussions)
PO 402 Perform Intial Assesment
402.01 Airway
402.02 Breathing
402.03 Circulation
402.04 Shock/IV Conterversy
PO 403 Perforn Rapid Tramua Survey
403.01 Head Injuries
403.02 HEENT
403.03 Chest Injuries
403.04 Abdominal Injuries
403.05 Pelvic and Extremity Fractures
403.06 C Spine/Back Trauma
PO 404 Combat Related Injuries/Treatment
404.01 Burns and Blast Injuries
404.02 Soft Tissue Injuries
404.03 NBCW
404.04 Analgesia in the Field
PO 405 Casevac
405.01 Prepare the causalty for Tpt
405.02 Carries, Lifts, Improvised Stretchers
405.03 Improvised rescue techniques
405.04 Veh and Medical Equipment Famil
PO 406 Mass Causualty/Triage
406.01 Mass Causualty/Triage
PO 407 FTX/Scenarios
LFWA ran 3 Serials from time period of Jun 03-Mar 04. The last two serials all candidates (all cbt arms) were qualified to PHTLS. Revision is now in the hands of CFMG. The course was 5 weeks in duration.
Week 1/2 Prestudy Package (under supervision of Medical staff)
Week 3/4 Course Content including Low/high speed scearios
Week 5 FTX
FTX was 24/7 5 days (Dismounted Platoon tasks)
Infantry Platoon dismounted org (32 pers/ 8 per section).
assesed medicall and cbt tactics
Fully equiped Light Infantry Equipment and full Cbt loads
(Body Armour/Wpns/NVG's/NBC/Radios/Ammo/Rations etc)
Veh platforms included LSVW Amb, Bision Amb, LAV 3, Coyote, BV206, CH 146
PO 401 Tactical Combat Casuality Care Concept
401.01 Intoduction/Legal Considerations
401.02 Review of TCCC/Crse Objectives
401.03 TCCC Part 1,2,3
401.04 Scenario Homework (Presentations and Discussions)
PO 402 Perform Intial Assesment
402.01 Airway
402.02 Breathing
402.03 Circulation
402.04 Shock/IV Conterversy
PO 403 Perforn Rapid Tramua Survey
403.01 Head Injuries
403.02 HEENT
403.03 Chest Injuries
403.04 Abdominal Injuries
403.05 Pelvic and Extremity Fractures
403.06 C Spine/Back Trauma
PO 404 Combat Related Injuries/Treatment
404.01 Burns and Blast Injuries
404.02 Soft Tissue Injuries
404.03 NBCW
404.04 Analgesia in the Field
PO 405 Casevac
405.01 Prepare the causalty for Tpt
405.02 Carries, Lifts, Improvised Stretchers
405.03 Improvised rescue techniques
405.04 Veh and Medical Equipment Famil
PO 406 Mass Causualty/Triage
406.01 Mass Causualty/Triage
PO 407 FTX/Scenarios
LFWA ran 3 Serials from time period of Jun 03-Mar 04. The last two serials all candidates (all cbt arms) were qualified to PHTLS. Revision is now in the hands of CFMG. The course was 5 weeks in duration.
Week 1/2 Prestudy Package (under supervision of Medical staff)
Week 3/4 Course Content including Low/high speed scearios
Week 5 FTX
FTX was 24/7 5 days (Dismounted Platoon tasks)
Infantry Platoon dismounted org (32 pers/ 8 per section).
assesed medicall and cbt tactics
Fully equiped Light Infantry Equipment and full Cbt loads
(Body Armour/Wpns/NVG's/NBC/Radios/Ammo/Rations etc)
Veh platforms included LSVW Amb, Bision Amb, LAV 3, Coyote, BV206, CH 146
- Reaction score
- 0
- Points
- 410
Looks good so far for course content.
It says your qualified to PHTLS, and not BTLS (they are really two in the same). Did they issue cards for qualification or just say that was the standard?
Most Med Techs are trained BTLS so that medical standard is more widely accepted amongst CFHS.
It says your qualified to PHTLS, and not BTLS (they are really two in the same). Did they issue cards for qualification or just say that was the standard?
Most Med Techs are trained BTLS so that medical standard is more widely accepted amongst CFHS.
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