A Critical Look at ‘TCCC’
Sometimes there can be a fine line between ‘objective’ and ‘subjective’, and it takes a critical perspective to discern the difference. This is my subjective, i.e. opinion, about what formal Tactical Combat Casualty Care (TCCC), meaning the Guidelines recommended by the Committee on TCCC (the CoTCCC) and published in Pre-Hospital Trauma Life Support (PHTLS) has become, and the best way to use them.
Let me start by saying that these guidelines were revolutionary when they were first published in 1996, even though they weren’t fully appreciated until probably 2003 (10 years after they were conceptualized) when the GWOT created a tangible requirement for them. They were the essential first step in changing the way medicine was conducted on the battlefield and creating an appropriate approach to casualties that was environment specific. And, like all committees, the direction that it has evolved into has been a series of compromises, general consensus based on data and opinions available, sometimes selectively presented, and more than likely a myriad of hidden agenda’s, open agenda’s and biases. Now I realize that is a strong accusation, unfounded, which is why I openly admit it is an opinion only. But by biases, I do mean formal open biases relative to the end user. What that means is that the CoTCCC produces guidelines and updates that are bias toward U.S. military operating in a combat environment. At the end of the day, the guidelines are an excellent foundation, and extremely important in mass implementation of an appropriate, defined, structured combat casualty care approach, specific to the U.S. military.
With the hyper-demand for TCCC training, even as far on the periphery as in preparation in home defense and even the doomsday preppers, it has created a vacuum for competent instructors on the topic. Everyone wants the training, and just about everyone is willing to provide it! The training cadres have become, even recommended to be by the CoTCCC, civilian first responders without any necessary practical, real world TCCC application experience or even relevant training to put it into appropriate context. Beyond that, for those with experience – just because someone is good at ‘doing’ it, doesn’t mean they are necessarily good a ‘teaching’ it. Instructing is a whole other skill set.
TCCC also makes specific product recommendations, which in and of itself, regardless of the data supporting it (or not supporting it), is a bias. Again the bias is particular to the audience it is intended for – the U.S. Military. For example, the drugs, or brands of products recommended by the CoTCCC may not necessarily be approved for use by appropriate regulatory bodies in allied countries. In Canada, this was one of the initial issues with adopting the guidelines verbatim. That is why, as far back as 2003, Canada started developing it’s own guidelines and in 2007 the Canadian Combat Casualty Care Working Group approved ‘Canadian TCCC Guidelines’ for use by the Canadian Armed Forces. Another example, was that the TCCC Guidelines (U.S. or CF) could not be seamlessly applied to domestic law enforcement. Hypertonic Saline Dextran (HSD or RescueFlow) was the fluid resuscitation of choice for the CF and fentanyl lollipops were the pain medication of choice, accessed through special permissions granted by Health Canada for use on operational deployments only. Law enforcement now has to make changes to the guidelines so that they are applicable to them.
But let’s take it a few steps further. There are companies that offer TCCC training, which, remember, was designed for use by American soldiers on the battlefield. How is that appropriate to apply to a domestic law enforcement environment in Canada, or any other country for that matter? There are huge differences in mission profiles, OrBat’s, ROE’s, TTP’s, drugs and equipment. Therefore, unmodified, they very quickly become inappropriate.
The CoTCCC will be the first to tell you that they are only publishing “Guidelines” and that it is up to the organization, including the Department of Defense in the U.S., whether they actually adopt them or should be modified based on specific requirements. This is a great disclaimer. A very interesting fact to consider is that after making the determination that the TCCC Guidelines no longer fit their mission profile appropriately, USSOCOM created their own version called TTP’s or Tactical Trauma Protocols, which were actually a relatively major modification to the CoTCCC TCCC Guidelines.
CTOMS™, being a training company with a broad spectrum of clients, has taken it a step further. While our approach is considered Intellectual Property, and the only way to learn it is to take one of our courses, the approach we take is much more universal and at the same time, very specific to each client’s mission profile. It allows for seamless integration of an agencies existing protocols, and in the absence thereof, offers CTOMS™ recommended procedures. We actually don’t teach cookie cutter, ‘TCCC’ courses. The foundation does remain to be TCCC, and the updates from the CoTCCC are always taken into consideration, but the content has evolved to be very different, and I would argue, much more appropriate in a universal fashion. We’ve branded ours TTC™, or Tactical Trauma Care™ guidelines, and it is a unique approach, I would argue, in my very bias opinion, an extremely effective, universal approach to managing a casualty in the non-permissive environment.
So critically consider the guidelines that you adopt for your agency to use. There are no rules that say you can’t modify them to fit your mission profile. And be very critical about the content that companies are offering to train your agency in. Not all ‘TCCC’ is presented equally. Does this make TCCC irrelevant? Definitely not. The point I’m trying to get across is that it’s designed for the U.S. military. If that’s not you, then you need to critically look at your environment and make modifications to fit your specific mission profile.