Corps adopts new casualty care guidelines - Marine Corps News | News from Afghanistan & Iraq - Marine Corps Times

Corps adopts new casualty care guidelines

Marines will now get more in-depth training on treating battlefield casualties with an update to the Tactical Combat Casualty Course.

The revamp of the course’s curriculum will provide Marines with more information on keeping a casualty breathing, stemming blood loss and treating eye injuries.

The changes are summarized in the July 21 Marine administrative message 406/10, and are aimed at standardizing training, while going into a deeper level of detail in certain areas of casualty care.

As before, different levels of proficiency are expected and depend on the role Marines serve in their units. Most Marines will achieve a basic level, while others who are designated combat lifesavers will reach a higher proficiency level. Navy corpsmen will be expected to have the highest proficiency in the TCCC skills set and will continue to train Marines.

In addition to the switch to Combat Gauze as a clotting agent and the replacement of the TK-4 tourniquet with the CAT II tourniquet, the message also formally changes the term for casualty evacuation, or CASEVAC, to tactical evacuation, or TACEVAC.

Those and other changes outlined in the TCCC guidelines are derived from best practices and lessons learned downrange, which are reviewed and incorporated into training as close to real time as possible.

The course is broken down into three sections — care under fire, tactical field care and tactical evacuation care — and changes are reflected in each section.

Here are some other changes set forth in the MarAdmin:

Care under fire

• The use of hemostatic agents is deleted, and more specific guidance on the use of tourniquets directs the caregiver to apply it over a casualty’s uniform.

The CAT II — combat application tourniquet — is a one-handed tourniquet that uses a cylindrical crank handle to provide pressure and locks into place. The TK-4 model it replaces uses an elastic latex band with a steel S hook at each end and is just as effective. But when Marines showed a preference for the CAT II and started buying it on their own, the Corps followed suit.

Combat Gauze replaces QuikClot, a hemostatic powder that’s poured directly into a wound and sometimes burns surrounding skin, making the removal of dead, damaged or infected tissue difficult.

Tactical field care

• Treatment of penetrating eye trauma was added, with guidance to first perform a quick visual acuity test; if the eye needs to be covered, a rigid patch, not a pressure patch, should be used; if the casualty is not able to orally take the 400 mg moxifloxacin antibiotic tablet provided in the combat pill pack, an intravenous or intramuscular antibiotic should be administered.

• Additional detail in the breathing section specifies the use of a 14-gauge, 3.25-inch needle to decompress a casualty who may have air or gas pressuring the lungs or has suspected torso trauma. Guidance also is given for placement and direction of the needle.

• The breathing section also guides the caregiver to immediately cover a sucking chest wound with an occlusive, which is an air- and water-tight dressing, and monitor the casualty’s chest cavity for the possibility of a collapsed lung.

• More detail in the bleeding section reinforces use of a tourniquet, guiding the user to place it 2- to 3-inches above the wound and recommends a minimum three minutes of pressure when using Combat Gauze.

When time and conditions permit, the guidelines state, the caregiver should ensure there is no pulse on the affected limb below the tourniquet. If there is, the use of a second tourniquet should be considered to avoid further blood loss.

• Documentation of care will be noted on a TCCC casualty card.

Tactical Evacuation Care

• Change of terminology from CASEVAC to TACEVAC. This change also applies to the term medical evacuation, or MEDEVAC.

• Treatment protocols are the same as outlined in the tactical field-care section, with reassessments to the casualty.

The concepts that created TCCC were developed in 1996 as a Special Operations initiative and in 2001 the Committee on Tactical Combat Casualty Care was stood up as a vehicle for gathering lessons learned on the battlefield for analysis and incorporation into training and operational guidelines.

The committee has medical representatives from all the services, including Navy corpsmen, conventional Army and Special Forces medics, Air Force pararescuemen and civilian medical professionals including trauma surgeons, emergency medicine and critical care physicians, scientists and educators who meet quarterly.

The TCCC program is credited with significantly reducing the number of fatalities on the battlefield and creating the highest combat survival rates in U.S. military history.

Guidelines established by the TCCC committee were reviewed by all the services and have been adopted by the Marine Corps.

To see TCCC changes online, go to www.lejeune.usmc.mil/fmtb/index.shtml.