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New program could drastically cut KIAs

Mar. 17, 2013 - 10:50AM   |  
Marines from the 15th Marine Expeditionary Unit treat a simulated casualty during a Combat Life-saving Skills course Aug. 24 aboard the Rushmore. The four-day course teaches service members the basic level of Tactical Combat Casualty Care in order to stabilize casualties on the battlefield.
Marines from the 15th Marine Expeditionary Unit treat a simulated casualty during a Combat Life-saving Skills course Aug. 24 aboard the Rushmore. The four-day course teaches service members the basic level of Tactical Combat Casualty Care in order to stabilize casualties on the battlefield. (Lance Cpl. Timothy Childers / Marine Corps)
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When Sgt. 1st Class Lance Vogeler died in combat in Afghanistan in 2010, there was nothing medics or fellow soldiers could have done to save him, said physicians who reviewed his case.

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When Sgt. 1st Class Lance Vogeler died in combat in Afghanistan in 2010, there was nothing medics or fellow soldiers could have done to save him, said physicians who reviewed his case.

In fact, none of the regiment’s other 32 combat deaths from 2001 to 2010 was preventable, doctors said. And only one death after evacuation to a hospital was deemed potentially survivable.

Those grim-sounding figures represent a remarkable achievement: Zero preventable deaths means the regiment saved every one of its members who possibly could have been saved. They did everything right to treat their wounded comrades — stanched bleeding with tourniquets, used clotting agents to halt hemorrhaging and properly kept airways clear.

In comparison, a 2012 study found that fully one-fourth of U.S. combat deaths from 2001 to 2010 were considered “potentially survivable” had those troops received better, timelier battlefield care.

The key to the 75th Ranger Regiment’s ability to save 387 wounded soldiers holds lessons for all combat doctors and leaders, say advocates of Tactical Combat Casualty Care, a trauma response program focused on preventing bleed-outs, suffocation and infection.

If the program was taught to all combat troops and medical personnel, preventable combat deaths could potentially be cut to zero across the force, members of the Defense Department’s Joint Trauma System said.

“We’re suggesting that everyone who deploys gets trained … and these commands own their casualty response system. If they do that, we’re going to have improved survival,” said Army Col. Erin Edgar, U.S. Central Command surgeon general, who traveled to Afghanistan with other JTS members late last year to study TCCC implementation.

The program differs markedly from traditional first-response training. It has been widely accepted by special operations troops, but regular units have been slower to embrace it.

In the past, front-line medics usually pumped patients with fluids, inserted IVs and immobilized spines for back and neck trauma. Use of tourniquets was discouraged, and they had no access to drugs to halt bleeding or prevent infection.

But under TCCC, corpsmen and medics — or, in Ranger and other special operations units, whoever is first on the scene of an injury — use tourniquets to stop life-threatening bleeding, carry gauze and other materials that clot blood, and know how to insert thin chest tubes and lines that feed medications into bone marrow.

Probably the best example of TCCC training at work in the 75th Ranger Regiment is Medal of Honor recipient Sgt. 1st Class Leroy Petry, who in 2008 in Afghanistan famously put a tourniquet on his right arm after it had been blown off by a grenade he had picked up and tossed to save other soldiers. Petry had been shot in the legs minutes earlier, but after practicing self-help medical care, he kept fighting.

While medics, corpsmen and airmen are eager to learn TCCC, many doctors, nurses and physician assistants have never received the training.

“They cannot effectively supervise TCCC programs if they have not been trained in it,” said retired Navy SEAL Capt. Frank Butler, chairman of the Pentagon’s Tactical Combat Casualty Care Committee.

The team also found that some units are uncomfortable letting personnel administer painkillers and antibiotics intravenously.

“There’s always the friction of change,” Butler said. And in medicine, officials must “win over a large number of organizations and individual practitioners.”

The group has recommended that the Pentagon stand up a rapid fielding initiative to get new TCCC techniques and technology to the field. It also is encouraging the services to train all combat unit personnel in the basic TCCC program and medical personnel in instructor-level response.

The 75th Ranger Regiment embraced TCCC techniques early on. In 1998, then-Col. Stanley McChrystal, who would later rise to four-star and command the war in Afghanistan, directed all Rangers to get medical training and, in fact, the Ranger First Responder Course was built on TCCC principles.

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