Tactical combat casualty care ( TCCC )

[JANES]

Everybody sure does a good job of letting everybody else know how smart they think they are.  But does anyone really know how this is going to be implimented and standardized nationally? 

 

[Fraser.g]

For someone who has ZERO info in their bio you are certainly pontificating allot. The answer is that it is still in the developmental stage. We have offered as much info as there is at this time. If this does not satisfy you then I am sorry but that is all there is.

In the future I would suggest reading all the posts in all related columns before demanding information on a subject.

Have a great day.

 

[JANES]

Who's developing it?

 

[Fraser.g]

Once again

From Armymedic "CF H Svc Gp will, eventually"

 

[excoelis]

To teach someone to stop bleeding and crack a chest is not enough, you need to teach them how and when to do these skills in a tactical and combat environment, hence its name.   You can read all the slideshows and books you want, but to truely understand it you need the experience.   So I'll ask again, who will develope the standards and who will teach it?  

Sorry to wade in on a discussion that is outside my area of expertise, but this latest from Janes strikes me as a sophism or 'circular logic'.   I would like to see some of you fine folks teach me and the boys some of this new shit before heading back over to the sandbox.   So if we all sit around arguing that if you don't have operational experience in a tactical environment then you can't teach it - then we will deploy with the same old shit - while the argument continues and the wealth of knowledge remains untapped.   So if no one makes the call, teaches it, and tries it out operationally then it is relegated to another great idea that never came to fruition.   Shit or get of the pot I say.   Personally, I'm impressed by the positive forward thinking research and discussion going on here.   Conversely, I see no benefit to me and the boys from negativity without advice or solutions.   I don't plan on recruiting my troops from the local penitentiary before going down range just because I know they have 'trigger time'.

 

[JANES]

I like this guy!

 

[Armymedic]

I would like to see some of you fine folks teach me and the boys some of this new crap before heading back over to the sandbox.  

So if no one makes the call, teaches it, and tries it out operationally then it is relegated to another great idea that never came to fruition.   crap or get of the pot I say.  

We are pushing it. Edm is did courses 2-3 weeks long, and cont to instruct thier guys before going over. After the well recieved courses that were run in Pet for Roto 0, we've got 20+ cbt arms taught prior to deployment training for roto 3, and plans to teach about 50 more. The team I am with (14 Snr NCO and Officers), I spent a day teaching the lectures and introducing the skills so in one day upon arrival to theatre we can test them, and they will be able to do the skills.

But we are at the bottom pushing up....nothing goes quick that way.

As for standards, Pet and Edm are doing thier own courses, with thier own style and content. There is no standard. A working group in Health Services HQ has been developing the standarization and implementation of a CF Cbt first responder course for about a yr now, and it is one of several areas for improvement that is being developed. The closest standard we have is Cpl Kopp's article in the Lessons Learned Pub, and a great standard it is.

Who will teach?  In Edmonton they used BTLS and PHTLS inst qualified Medics and infanteers. In Pet, because we only teach the medicine, we use BTLS instructors with PA's and MO's for evaluators.

 

[Fraser.g]

Excoelis

This is where we are as far as I know.

There was a pilot course taught by 1 Fd Amb to selected members of 3 VP before their deployment. From what I understand the course was quite expensive to run. It was 2 weeks long with the first week being dedicated to the medical interventions taught and methods of evacuation so that the candidiates were familiar with the kit like Bison Amb and Helos kited out with litters etc.

The second week was an FTX where the candidates rotated through the part of the Combat First aider on fighting patrols and other tasks. They got bumped and moulaged casuaties were introduced. The First Aider had to act accordingly to prioritize and evac the cas when apropreate in the tactical scenario.

It was expensive because of the Helo support and the insane ammount of blank ammo and pyro used.

IMHO it could be done in less time for money. Yes the pilot was a great course and I would have loved to teach on it but I believe the cost will make the bean counters balk.

So this brings us back to the main question. "How do we get this product from the medical side of the house to the pointy end where it is needed?"

I believe the answer is a two pronged approach.
1. there has to be a will from within the medical comunity to pass the infromation down and provide a course that is both cost and time effective while simultaniously provide an end product that will save lives on the battle field. The US has proven in the past two years that this avanue of treatment works.

2. There has to be an increased pressure from the combat arms units to CFMG to provide this course. The "Dispatches" on the topic is a great step in increasing the awairness of the course to the "Zero" trades.

We as the end providers and users must keep up the pressure or this innitiative will fall by the wayside as so many other great ideas that loose steam.

So what can the individual do?

1. Request the course up the chain of  command.
2. Request it again
3. and again
4. repeat steps 1-3 until the desired result is attained.

GF

 

[excoelis]

Yessss........the beancounters and their self-aggrandizing, self-perpetuating beauracracy.  I love how they sit on shit like this and Light Forces doctrine so they can feel impotent........oops Freudian slip......important.  Fact is the troops at the coal face are quite adept at identifying needs and persuing results with a vengeance, particularily when it is of grave consequence to do nothing.  We have had Docs from 'certain communities' teaching TCCC on the Patrol Pathfinder course for a few years now.  How is it that as a student or Instructor on a COURSE you can get that, and actually deploying operationally in that role you have to wait until some pompous ass makes it all HIS idea?  I suppose that question is rhetorical :

Good luck with the push boys...........don't worry the pull is already there!

I'll let you guys get back to your blah-blah-50ml-plomywhateverstuff discussion and I'll go back to beasting the cadets in one of their threads ;D

 

[Radop]

Excoelis

There was a pilot course taught by 1 Fd Amb to selected members of 3 VP before their deployment. From what I understand the course was quite expensive to run. It was 2 weeks long with the first week being dedicated to the medical interventions taught and methods of evacuation so that the candidiates were familiar with the kit like Bison Amb and Helos kited out with litters etc.

2. There has to be an increased pressure from the combat arms units to CFMG to provide this course. The "Dispatches" on the topic is a great step in increasing the awairness of the course to the "Zero" trades.

I am reading that right now, very interesting as I am a First Aid instructor.  I thought that what you discribed was like MCM in St Johns Ambulance's first aid with a  combat perspective.  I do see wholes in SFA and CPR trg but for all soldiers in Garrison, I think it is evective and appropriate.  I would like to see all instructors qualified to this level to teach all field trades not just combat arms.


What is the plan for the future of this course, as an instructor for St Johns first aid, I would love this course.

 

[Radop]

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 think that it coming from him was definitely an eye opener.  Let some of our snr people know what would happen it they were to listen to their men.  I recommend the read as I am half way through the book now.  I would like to take the course and am a First aid instructor. :

 

[JANES]

St Johns ambulance first aid goes against the majority of what is taught in TCCC.  Everything from casualty approach to the use of tourniquets and the non use of CPR, removing dressings if the bleeding is not controled and even pushing bowel back into the gut, all goes against St. Johns teachings.  TCCC is as much tactics as it is medicine.  There is no tactical scope in St Johns, and an advanced first aid instructor won't have the knowledge on anatomy physiology and skills to properly teach it.  The new dispatches explains this all well.  It is what TCCC is trying to get away from.  It is great for the Gari-trooper that wants to get their CDS commendation for doing CPR on some fat civi who had a heart attack at McDonalds, but I see no scope for for the cross over.  It would be going backwards. 

 

[Fraser.g]

Radop

The Combat First Aid course utilizing the TCCC approach is not for garrison life nor exercises. It is for a tactical environment where the mission comes before the immediate concerns of the individual while simultaneously trying to preserve as much of your own manpower as possible while trying to deny the same to the enemy. It is not for any scenario where you have the luxury of calling End Ex or No duff and shutting things down while your get your wounded out. I see from your bio that you have many tours under your belt. Should select members of every section have access to this information... Yes, and it should not matter what trade you are. Should the combat arms trades have first crack? Yes, because they have a greater chance of using the skills. It is much more advanced than anything that St Johns teaches or would want to take liability for. The bare minimum level of instructor for the course is an ALS Medic.

GF

 

[Radop]

St Johns ambulance first aid goes against the majority of what is taught in TCCC.   Everything from casualty approach to the use of tourniquets and the non use of CPR, removing dressings if the bleeding is not controled and even pushing bowel back into the gut, all goes against St. Johns teachings.   TCCC is as much tactics as it is medicine.  

I thought you were a medic.  If you look at MCM again, cardiac arrest casualties are lowest priority.  Tourniquets are discouraged in St Johns ambulance not disreguarded.  As for the bowels back into the gut et al, the reasoning as you should know if you read Lessons Learned, is due to availability of medical aid.  Leaving organs out for 72 hrs would definitely cause complications.  St Johns Ambulance teaches similar techniques in wilderness first aid as what is proposed in TCCC except for tactical considerations.  Tactics is the biggest difference I see between TCCC and St Johns Ambulance.

There is no tactical scope in St Johns, and an advanced first aid instructor won't have the knowledge on anatomy physiology and skills to properly teach it.   The new dispatches explains this all well.   It is what TCCC is trying to get away from.   It is great for the Gari-trooper that wants to get their CDS commendation for doing CPR on some fat civi who had a heart attack at McDonalds, but I see no scope for for the cross over.   It would be going backwards.  

So what you are saying is that medics know tactics and medicine well enough to teach this course!  I have seen few medics that can teach anything about tactics and even fewer that are attached to Coys in the infantry.  As for knowledge about anatomy, I took physiology in university and somehow passed yet me is just a sig op.  You expect to teach infanteers this knowledge yet you say they could not teach it once they were qualified?

As for Gari-troopers, tell that to MCpl Hamilton and Cpl Matthews who crawled through minefields to reach Sgt Short, Cpl Beerenfinger and Cpl Stirling (who they were able to treat and enabled him to survive possibly) and have been announced as being awarded the Star of Courage.  Yet they did this with only the St. Johns Ambulance course.

I think that first aid instructors would be able to get the anatomy knowledge down.  I know what a presure point is, what a flailed chest is, and other injuries are and building on what we already know would be better for us all.  Things like standards should and must be controlled by medics as they should be the ones that are the best trained for combat first aid.  We would be the ones who would have to carry out the first aid in combat situations.  In our trade, we are often sent out on RRBs where we are left on our own accord.  We ussually have no medics and if the vehicle is downed, we may have to defend our location until reinforcements and casevac arrive.  Can the medics train 1 in 8 to be a TCCC soldier especially if a Battle Group of 2500 is departing to lets say, Afghanistan?  I know a lot of first aid instructors that are more trained in medical care than medics.  Plse don't downplay the role this training provides.

Further to that, most of my time in the military has been spent in Canada.  TCCC would not be the best method of treating wounds in this case as medical aid would be brought in within one hour.  The procedures outline in St Johns first aid would be the best steps to follow.  As for saving someone at McDs, should we not try to preserve life of all Cnd people?  Do we only protect people who meet our fitness criteria?  If you are a medic, do you only treat people who get injured while you are on duty?  I enjoyed learning Children CPR as it was something I could do if my child ever suffered an injury that caused their hearts to stop such as electrocution.

 

[Radop]

Should select members of every section have access to this information... Yes, and it should not matter what trade you are. Should the combat arms trades have first crack? Yes, because they have a greater chance of using the skills. It is much more advanced than anything that St Johns teaches or would want to take liability for. The bare minimum level of instructor for the course is an ALS Medic.

I see but as I stated above, I feel you would get swamped with the numbers if what was proposed in the Lesson Learned dispatch comes to fruition.  I believe that Combat Support units are almost as high for casualties especially Eng who are exposed to land mine clearances under tactical settings.  Artillery on the other hand are 7 Km or further from the enemy at most points in battle.  One of the people developing the plan was an infanteer (although a paramedic trained one) so I think that having others trained as instructors and standards being a medic responsibility would be best and most cost effective (as this is the most important point for COs).

 

[Armymedic]

Ok lets sum up this argument as to who will teach the TCCC/ Cbt First responder/ or whatever....

All medical services and treatments provided to the members of the CF fall under the legal responsibilities of the Surg Gen. Those responsibilities are delegated down thru the med chain to the lowest level at the MO, PA, NP level. Med Techs are authorized to provide medical services with a specific scope of practice that is allowed thru that chain, but ultimately its the supervising MO, PA or NP who is responsible for maintenance of the standard.

So for an TCCC/Cbt first responder trained nonmedical person to be able to practice and use the medical skills (and hence teach them as well...) they must first gain approval of their command (brigade, wing, fleet) Surgeon.

These Majors, who are no different then any other officer, trust in their Snr NCOs and troops. They trust in their skills as medics and as instructors.

For this reason, all medical training on these courses will be conducted by Medical capbadge wearing personnel.

Radop does bring up a good point, as FAI could possibly teach this. Not wrong as a good instructor with a sound knowledge of the subject matter will be a capable instructor regardless of the subject. But the skills taught and tested on the course are outside the acceptable "scope of practice" for a FA qualified CF member. But a Cbt Arms Snr NCO or MCpl FAI would be a good skill set to teach the tactics portion of the course.

Anyway we are all arguing the definition of fruit here. Apples are the best fruit. No oranges are the best fruit. No pears are the best fruit.....

It really doesn't matter as long as we get to eat good fruit.

 

[excoelis]

It really doesn't matter as long as we get to eat good fruit.

.......and you are what you eat, you....... ;D

 

[Radop]

RN RPN and Armymedic thanks for your imput.  

Armymedic, what I can assume is the main reason is that the procedures are more of a 'medical' procedure than a 'first aid procedure' and as such you must be taught by medical personnel approved/under the direction of a doctor.  This would be similar to the use of AEDs which needs you to be certified by a medical doctor.  Is this correct or am I missing something?  At least your not telling me I wouldn't be able to figuar out anatomy.

RN RPN, I understand that you would not use this on exercise, domestic ops or even probably on peacekeeping missions.  On deployments such as OP APOLLO or ATHENA, the use of both SFA or TCCC would be required depending on the situation both tactical and availability of Casevac.

Unlike what Jane said about SFA only being good if you want to treat someone having a cardiac arrest at McD, first aid is a way of assisting people in need of help.  I have assisted many people with the knowledge I have and most of the time all I have had to do is "steady and support until medical aid arrives".  I am not a doctor nor do I profess to be.  I do believe to be knowedgeable in tactics (former infanteer, signals operator) and am getting comfortable in instructing first aid.  All the IT say that the best course to teach is wilderness first aid as it covers a lot of care outside the scope of 'steady and support' and goes into improvised methods of treating until you can get to medical aid or medical aid gets to you.  She also states that SFA goes against what is taught in TCCC.  I disagree with this assessment as they talk about quite a bit of the similar priorities as MCM in SFA.  The amount of stuff you can do with TCCC is greater than SFA and takes into account the tactical environment.  In SFA this would fall under step 3 of ESM, assess the hazards.  If you cannot do first aid 'cause your receiving fire, you must first supress the fire and win the firefight.  I don't really see how they are opposites?

My last question (at least for now, lol) is would we be able to use this in garrison or like Wilderness first aid, is only used when medical help is unavailable for a long period of time?

 

[Armymedic]

.......and you are what you eat, you....... ;D

WO,

thats bad... :

 

[Armymedic]

My last question (at least for now, lol) is would we be able to use this in garrison or like Wilderness first aid, is only used when medical help is unavailable for a long period of time?

As it stands now, the "qualification" only lasts as long as you are on overseas deployment.

But this question is one of the many being worked out as the development of the recognized course continues.