Special Forces Medicine

Tactical Combat Casualty Care benefits forces worldwide

UNIPATH STAFF

The lessons Afghan Air Force Master Sgt. Abdul Majid Watandoost imparts to his students could mean the difference between life and death on the battlefield.

As the senior medical trainer for the Kandahar Air Wing in southern Afghanistan, Watandoost teaches Tactical Combat Casualty Care (TCCC) to flight medics. What they learn from the course is vital to support successful military missions and save the lives of wounded comrades.

But TCCC is not just for medics. This particular course is designed to “train the trainer.” The flight medics are charged with passing their newfound knowledge to nonmedical military personnel, often the first to treat casualties on the battlefield.

These skills help combat Soldiers complete their missions while avoiding preventable deaths. The vast majority of combat deaths occur before a Soldier gets to a medical facility. Basically a combination of military and medical tactics, TCCC helps Soldiers keep patients alive long enough to reach doctors and operating tables.

“I just wanted to help the Wounded Warriors and all my Afghan brothers,” Watandoost said.

In 2013 Watandoost became certified in TCCC, which allows him to train and certify other medics — his personal contribution to the future of his country. “I believe Afghanistan will be self-reliant, but we have to work hard,” he said. “What I’ve learned, and continue to learn, I must teach to the medics in my clinic, or we won’t be able to do our mission.”

While the goals of TCCC are simple, achieving them requires complex decision-making in high-stress combat environments:

• Treat the casualty
• Prevent additional casualties
• Complete the mission

SOF origins

Initially developed in the mid-1990s by U.S. Special Operations Command, TCCC incorporates lessons learned from experiences in Iraq, Afghanistan and elsewhere. Better protective gear and medical equipment — such as high-tech gauze that speeds up blood clotting — have contributed to saving lives, but TCCC has played an important role in increasing the survival rate of combatants.

TCCC guidelines, first designed for special operations forces, have been adopted across all U.S. military forces and passed along to many partner nations. In fact, a survey of U.S. combat Soldiers found that the service members valued TCCC training second only to individual weapons training. This exemplifies how special operations forces introduce groundbreaking innovations for the betterment of all Soldiers.

TCCC overview

Soldiers must be prepared to provide medical care under darkness, harsh weather and, most critically, enemy fire. “Good medicine can sometimes be bad tactics; bad tactics can get everyone killed or cause the mission to fail. Doing the right thing at the right time is critical,” according to the U.S. Military Health System’s introduction to TCCC.

Divided into three phases — care under fire, tactical field care and tactical evaluation care — TCCC breaks down how Soldiers should address medical treatment. For instance, when a Soldier is wounded by gunfire, also known as the care-under-fire stage, the first thing an unwounded comrade should do is not tend to the Soldier, but instead return fire in the hope of preventing further injuries. The next step is to move the casualty to a safe area, rapidly assess bleeding to arms and legs and, if necessary, apply a tourniquet.

In the past, many Soldiers falsely believed tourniquets did more harm than good and cost comrades arms and legs. Today, medics proudly promote the humble tourniquet as one of the most valuable medical tools on the battlefield. Soldiers whose wounds were treated promptly with this basic instrument showed vastly higher survival rates.

The training guidelines are continuously updated to ensure these best practices are applicable to the changing variables of combat.

Sharing Information

A credit to its profound impact on saving lives, TCCC training has spread to militaries across the world. Multilateral exercises have helped medical trainers from different countries share these tactics and best practices. For instance, during Jordan’s Eager Lion 2012 military exercise, which included forces from 19 countries, medics underwent a refresher course about the latest trends in TCCC.

“You have your ground forces that get together and exchange information and tactics,” said U.S. Capt. Rob Clontz, who took part in the TCCC training during Eager Lion. “We can do the same in the medical field. It’s not really that much different, in my mind.”

Jordanian Col. Rateb Abuzaid of the National Emergency Medical Service Education Center in Amman, where part of the TCCC training took place, agreed with his U.S. counterpart.

“It’s very important that we have our instructors trained well to be able to distribute this standard to our Soldiers and officers in all of Jordan’s Armed Forces,” Abuzaid said.

These types of medical exchanges are taking place across the region. After an attack on an outpost along the Afghanistan-Tajikistan border several years ago that killed several Tajik border guards, military leaders decided TCCC might have saved the men. In 2011, border guards from six outposts in Shurobad district received the new training to manage medical treatment during skirmishes with drug traffickers or violent extremist organizations.

Future Focus

As technology, training and medicine evolve, so will battlefield medical care. Military leaders expect pre-medical-facility treatment for combat Soldiers to become even more successful in increasing survival rates for the wounded.

Periodic updates to TCCC guidelines, as well as multinational training to share best practices and experience, will shape the future of combat medical care.  

Three phases of Tactical Combat Casualty Care

1. Care under fire
   Provided while under hostile fire. Only the most basic of care is provided, such as application of a tourniquet to stop life-threatening bleeding, so that the first responder can return fire and prevent additional injuries to the wounded Soldier and his team.
2. Tactical field care
   Provided once hostile fire has subsided. Medical equipment is limited, but more treatment can be provided than during the previous stage, such as ensuring the Soldier has adequate oxygen.
3. Tactical evaluation care
   Provided while the wounded person is being transported to a hospital.