ARNOLD AIR FORCE BASE, Tenn. -- “It is better to be a warrior in a garden than a gardener in a war.”
This proverb encourages preparation. It calls for people to take advantage of calm times to hone their skills, as their abilities may be needed immediately should the quiet be suddenly shattered.
Although Tech. Sgt. Mark Friskel has heard the adage many times over the course of his Air Force career, for him the expression most perfectly encapsulates the purpose behind Tactical Combat Casualty Care.
Tactical Combat Casualty Care, or TCCC, sets a training standard across the entire Department of Defense with evidence-based lifesaving techniques, strategies and procedures, allowing those who have been trained to provide best practice trauma care both on and off the battlefield should they encounter a situation in which a fellow Airman is wounded and needs swift assistance until further help can arrive or the injured can be safely transported from the scene.
“TCCC gives members the tools and tactics necessary to provide immediate lifesaving care,” Friskel said. “The ability comes from their desire to maintain and hone their skills and their willingness to act when needed.”
On Aug. 15, the initial crop of trainees either stationed or employed at Arnold Air Force Base completed the first TCCC course held at the installation. The class, instructed by Friskel, an independent duty medical technician at Arnold, was comprised of six members selected due to job and mission requirements.
The Arnold service members, security personnel and law enforcement officials who participated received both video and hands-on instruction for several lifesaving techniques, including wound packing, pressure bandage application and tourniquet administration.
At the end of the training, each participant was assessed on his ability to apply his newly-acquired TCCC knowledge in a distinct scenario. Injuries that these trainees were tasked with addressing in these simulated situations included blunt force trauma caused by a fall, lacerations caused by a machinery mishap and massive bleeding caused by a shooting.
The goal of TCCC is to reduce the number of preventable deaths. In a 2012 article titled “Death on the battlefield (2001-2011): Implications for the future of combat casualty care,” Col. Brian Eastridge and his co-authors wrote that of the nearly 4,600 battlefield fatalities analyzed between October 2001 and June 2011, approximately 87% of these combat-related deaths occurred in pre-hospital settings. Of those, it was determined 24% could have been potentially survivable, as they were a result of either uncontrolled or improperly-controlled bleeding or an unmanaged airway.
To improve outcomes for combat casualties with potentially survivable injuries, TCCC prioritizes addressing the primary causes of battlefield deaths first. The “MARCH” acronym is ingrained in TCCC trainees, as it spells out the order in which care should be delivered. The “M” stands for massive bleeding, the leading cause of potentially preventable deaths across the DOD. Trainees are taught how to check for life-threatening bleeding and ways to stop it. The “A” stands for airway, and trainees are taught methods for opening a casualty’s airway. The “R” is for respiration, and methods to assess respiration and breathing are taught through TCCC. The “C” stands for circulation. TCCC provides guidance on how to monitor a casualty’s blood circulation and prevent shock. The “H” stands for hypothermia. To prevent hypothermia among casualties, trainees receive information on how to keep the injured warm and dry.
Friskel said the standardization offered by TCCC is important in that it establishes a baseline of knowledge and skill.
“All members having the same baseline skills to treat casualties helps to free up medical assets to focus on higher-priority or casualties with more advanced or invasive needs,” he said. “Also, if no medical assets are available, members can treat casualties, providing better chances of survival.
“It also instills a bit of confidence and comfort. You know everyone with you has the knowledge and skills to help if something should happen.”
Originally created in the early 1990s by the Committee on Tactical Combat Casualty Care for the Special Operations Command medical community, TCCC was developed as combat-appropriate and evidence-based trauma care based on injury patterns of previous conflicts. TCCC remained primarily in the Special Operations community until around 2012, when the committee was placed under the Joint Trauma System which itself became a component of the Defense Health Agency.
TCCC replaces Self-Aid Buddy Care, an Air Force training that served the same overall purpose of TCCC – to provide immediate support to the wounded until medical help could arrive. SABC training consisted of two parts. The first was computer-based training, or CBT, which included videos and PowerPoint presentations that trainees would view on their own time. The second part was hands-on training scheduled upon completion of the CBT.
Friskel noted an issue with SABC being a lack of uniformity in training and information presented.
“I have been an instructor providing training for 15 years at five different bases. I can tell you each base had their own way of providing the training,” Friskel said of SABC. “There was no standardization at all, just a bag of items they saw in the CBTs. I’ve seen some instructors go very in depth and some rush through it just to check a box.”
TCCC instead consists of a standardized didactic presentation with DHA-produced videos, handouts, training requirements and assessment tools.
“It ensures that all members are learning the information, not just clicking through a PowerPoint to get it done,” Friskel said of TCCC. “The slides and videos are much more informative and a lot easier to sit through. With standardized skills, instructions and assessment sheets, there is no question on what needs to be done and how it needs to be done.”
Friskel added there is “no comparison” between TCCC and SABC.
“TCCC is leaps and bounds above SABC,” he said. “It is much more interactive, flows much better and the members don’t have CBTs to click through. TCCC provides members important information in a way they can learn and retain it better and scenarios to practice and help to build confidence in the skills they are learning.”
Future classes could offer a greater variety of scenarios more specific to Arnold.
“We can create our own scenarios to fit the mission and jobs that members would likely encounter day-to-day, because this training isn’t just for combat, it can be utilized day-to-day to help save lives,” Friskel said.
July 1 marked the official sunset of the SABC program as the TCCC training requirement went into effect on that date. All DOD service members are required to obtain the initial TCCC training specifically developed for service members no later than April 2023.
The TCCC training provided to service members is good for a period of three years upon its completion. Friskel said because the DOD-wide TCCC requirement is new, officials are still working out some details concerning the training.
The information in TCCC is continuously being reviewed and updated through lessons learned in combat zones around the world as well as in trauma centers and through EMS. Therefore, Friskel said, the training is proven effective to save lives.
“It is better to have the knowledge and skills and never have to use them than to be in a situation where thoughts and prayers are the only thing you have,” Friskel said.