Need to Know Information

Battlefield Trauma Care Research, Development, Test and Evaluation Priorities

Tactical Combat Casualty Care Training for Deploying Personnel

AY Survey Summary for TCCC Equipment Evaluation

Report of the Army Dismounted Complex Blast Injury Task Force

Use of Dried Plasma in Prehospital Battlefield Resuscitation 2011-04

David W. Callaway, MD; E. Reed Smith, MD; Shapiro, Geoff Shapiro, EMT-P; Jeffery S. Cain, MD; Sean D. McKay, EMT-P; Robert L. Mabry, MD

The Committee for Tactical Emergency Casualty Care (C-TECC) was convened to expedite the appropriate transition of military medical lessons learned from the battlefield to civilian crisis response in order to reduce preventable causes of death in both our first responders and civilian population (Appendix 1: Mission Statement). The Committee for Tactical Emergency Casualty Care (C-TECC) is modeled after the Committee for Tactical Combat Casualty Care (CoTCCC) and is comprised of a broad range of interagency operational and academic leaders in the practice of high threat medicine and fire/rescue from across the nation, including members from emergency medicine, emergency medical services, police, fire, and the military Special Operations community. C-TECC remains an independent civilian entity, but maintains a close relationship with CoTCCC for guidance and support. (more)

A large contingent of highly trained and experienced tactical emergency medical personnel from paramedics to physicians gathered recently in Dumfries, Va., Aug. 2-4 to participate in a workshop designed to establish a standardized Tactical Emergency Medical System (TEMS) curriculum. Additionally, participants agreed to create a National TEMS Council (NTC) which will focus on research, policy, liaison, future TEMS agenda and leadership issues at the national level.

"A standardized TEMS curriculum will allow for agencies, jurisdictions, and others to know that those trained by such a curriculum meet a standard required by those in this demanding field," said Program Director Philip Carmona. "It will allow current training programs to crosswalk their respective curriculum against a standard that has been formulated by a known body of subject matter experts." More than 50 experienced participants attended including police, fire, and EMS organizations as well as local, state and federal jurisdictions, the Department of Homeland Security, Health and Human Services and Department of Defense. Workshop attendees reviewed 18 initial competency areas and voted (required 2/3 majority) to include, exclude and/or add to the existing document. Participants then broke into small groups to discuss the lifesaving, essential skill sets needed by tactical medics and operators. They ultimately agreed on17 competency categories. Upcoming meetings will focus on team commander and medical director skills. Workshop leaders Richard Schwartz, Director of The National TEMS Initiative (NTI) and Interim Chairman of the Council along with Carmona and co-chairs Dr. Craig Llewellyn and Richard Carmona, the 17th Surgeon General of The United States, helped coordinate the workshop and create the agenda. "The vast majority of goals were attained," said Carmona. "A significant milestone has been reached in the 'story' and actualization of tactical medicine organization in the convening of TEMS medics, operators, medical directors, administrators and researchers from diverse jurisdictions and agencies across the United States." Prior to the August workshop, several of the attendees had participated in similar initiatives and historically, attempts to unify tactical medicine have failed. However, as terrorism threats and incidents have grown and the ongoing concern for national preparedness and safety grows, a critical need for TEMS unification across all lines has become increasingly apparent.

The National Association of EMS Physicians and the National Disaster Life Support Foundation sponsored the event through CDC-TIIDE and unrestricted funding respectively. A follow-up meeting has been tentatively scheduled just prior to the Special Operations Medical Association Conference in Tampa, Fla., this December. For more information contact Philip Carmona at (706) 721-3314 or email PCARMONA@georgiahealth.edu

"On an average day, in excess of 12,000 special operations forces [SOF] and SOF support personnel are deployed in more than 75 countries across the globe."

- Adm. Eric T. Olson, Commander, United States Special Operations Command

The October 2010 intercepts of explosive-packed airfreight parcels originating from Yemen are just the most recent demonstrations that the national security threat against the United States of America and its allies, now known as the "new normal," is as real today as on Sept. 11, 2001. Unlike easily recognized, state-based threats, where the boundaries are clear and defined and the foes conventionally armed, these new normal threats are transnational, sophisticated, and ideologically driven. Frequently they are based on insurgent networks anchored in weak and/or failed states. The most visible such insurgent network is that of al Qaeda and its affiliates, which have grown like viruses in the Muslim nations of the Middle East, Asia, and Africa....more

The Coalition for Tactical Medicine announces the receipt of a generous donation from Combat Medical Systems (CMS), a distributer and innovator of tactical medical care products.

The Coalition for Tactical Medicine (CTM), an official 501(c)3 non-profit, started in April 2009 with the launch of their website and blog followed by a CTM board of directors meeting in San Antonio, TX. CTM's mission - Strengthen the lifesaving capabilities of tactical medical responders worldwide. (more)

These articles were located via: http://conflicthealth.com/

A military hospital's all-encompassing mission

Pediatrics isn't the only addition to what is considered possible and necessary in war-zone medicine. The hospital also has an interventional radiologist, who can snake catheters into bleeding sites that surgeons cannot reach. It has a 64-slice CAT scanner that would be the envy of any radiology department in the United States.

Medical research is part of the military's combat mission, too

The armed services are dedicated to saving every life, limb and eye of battle-wounded service members in Afghanistan and Iraq. The task requires not only skill and energy, but also the capacity to learn from failure and broadcast success.

War zone trauma cases yield medical insights

"Among the big challenges in medicine is taking up new stuff that works and letting go of the things that don't. My sense is that the military kind of has a handle on both," said Carolyn Clancy, director of the Agency for Healthcare Research and Quality, the federal agency assigned to finding ways to better apply existing medical knowledge.

Historically, civilian medicine has had a poor handle on those challenges.

Teleconferencing from the war zone improves treatment for wounded soldiers

The conference helps ensure no injuries are overlooked in patients who often have a dozen wounds or more. It's a way of double-checking innumerable pieces of information that have been entered into a database and will be studied to help improve practice. It's also a way of gently monitoring everyone's performance.

American College of Emergency Physicians (ACEP) has launched a free first-of-its-kind integrative training that covers the development and maintenance of pre-incident plans.

Under a cooperative agreement with FEMA, the American College of Emergency Physicians (ACEP) has launched a free first-of-its-kind integrative training that covers the development and maintenance of pre-incident plans ensuring the efficient distribution of patients, the sharing of information and resources, and the coordination between state and local agencies with hospitals and otheAdditional topics include patient and resource tracking, credentialing systems, deployable federal resources, principles of community emergency planning, and more.

This course is directed toward those working in emergency management agencies and healthcare organizations, especially in small communities and rural areas, which have primary job responsibilities other than disaster preparedness. It is also useful for those in public health, EMS, fire services, and other organizations involved in disaster preparedness. The four-hour online training is part of a training portal that has several components to it. Each state has its own virtual community to foster collaboration. Each virtual community includes a members section, the training modules, a Q&A section and a Forum section. For more information, go to http://www.acep.org. rs responding to the medical needs of disaster victims.

If you have not practiced non-traditional casualty movements such as drags utilizing webbing or straps to reduce friction be advised: traditional carries involving picking someone up bodily do not work well at all under combat conditions. If you are in doubt of this, some good training executed like your life actually depends on it while wearing full kit should illuminate the need for developing other, more rapid, rescue techniques. Only when you have moved the casualty to safety and out of the direct line of fire can you begin the third priority of work, treating the casualty, and then your treatments will be limited to stopping life-threatening hemorrhage...more.

In the mid-1990s, a Special Operations medical research project led by Captain Frank Butler, a former SEAL and Director of Biomedical Research for the Naval Special Warfare Command at the time, conducted an analysis of how best to take the principles of trauma care and incorporate them into the combat environment. This project produced a paper entitled "Tactical Combat Casualty Care in Special Operations, "which was published as a supplement to the journal Military Medicine in

August 1996. Th is paper included a proposed set of prehospital trauma care guidelines customized for use on the battlefield...more -Link to this article only

Link to NAEMT Full Newsletter

note: Dr. Steve Giebner is a member of the Coalition for Tactical Medicine Board of Directors

Richard Bruce Schwartz, MD, John G. McManus, Jr., MD, MCR, John Croushorn, MD, Gina Piazza, DO, Phillip L. Coule, MD, Mark Gibbons, Glenn Bollard, MD, David Ledrick, MD, Paul Vecchio, E. Brooke Lerner, PhD

ABSTRACT:(Link to full text)

Background. Tactical emergency medical support (TEMS)is a rapidly growing area within the field of prehospital medicine. As TEMS has grown, multiple training programs have emerged. A review of the existing programs demonstrated a lack of competency-based education.

Objective. To develop educational competencies for TEMS as a first step toward enhancing accountability. Methods. As an initial attempt to establish accepted outcome-based competencies, the National Tactical Officers Association (NTOA) convened a working group of subject matter experts.

Results. This working group drafted a competency-based educational matrix consisting of 18 educational domains. Each domain included competencies for four educational target audiences (operator, medic, team commander, and medical director). The matrix was presented to the American College of Emergency Physicians (ACEP) Tactical Emergency Medicine Section members. A modified Delphi technique was utilized for the NTOA and ACEP groups, which allowed for additional expert input and consensus development.

Conclusion. The resultant matrix can serve as the basic educational standard around which TEMS training organizations can design programs of study for the four target audiences. (full text)

Key words: tactical medicine; tactical combat casualty care; hemorrhage control

The two-week curriculum focuses on combat medic training, administrative databases, laboratory systems, radiology, dental procedures and medical supply. BAGHDAD -According to World Health Organization, Iraq ranks among the bottom third of the world's countries in healthcare for its citizens.The U.S. Department of State Provincial Reconstruction Team - Baghdad, United States Division - Center, and the 547th Medical Company, 261st Multifunctional Medical Battalion, 807th Medical Brigade, United States Forces - Iraq, are working to help change that through "Over the Shoulder" training for newly graduated Iraqi doctors. (more)

A new EMS deployment study has been issued by a broad coalition in the scientific, firefighting, EMS and public-safety communities. The study shows that the size and configuration of an EMS first responder crew and an advanced life support (ALS) crew has a substantial effect on a fire department's ability to respond to calls for emergency medical service. (more)

Original NIST report

By M. Jo McMullen, Senior Attending Staff Physician, Department of Emergency Medicine, Akron General Medical Center, Akron, Ohio; Professor of Clinical Emergency Medicine, Northeast Ohio Universities College of Medicine, Rootstown, Ohio; and Tactical Physician, Metro SWAT and Akron, Ohio, Police Department; and C. J. Williams, Research Coordinator, Department of Emergency Medicine, Akron General Medical Center, Akron, Ohio

Law enforcement administrators are expected to make decisions regarding requirements for personal body armor for their employees. Although cost and comfort are significant factors, the level of protection necessary to defeat the expected threat level must remain the primary consideration. The development of Kevlar by the DuPont Chemical Company in 1971 allowed the development of personal body armor that was light enough in weight for routine wear and yet strong enough to stop a .38-caliber lead bullet or a .22-caliber rifle round. The U.S. Department of Justice's National Institute of Justice (NIJ) Technology Assessment Program, now the National Law Enforcement and Corrections Technology Center (NLECTC), began a program of developing testing standards for this new technology. Many, if not most, law enforcement personnel are unaware of the background of that system. (more)

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. (more)

Non-Profit
Texas Health Presbyterian Hospital Dallas, Fogelson Forum Auditorium, 8200 Walnut Hill Lane, Dallas, TX 75231
Program Directors: Jeffrey S. Cain, M.D., Alan Frankfurt, M.D., Travis Hawkins, M.D., Wes Taylor, D.V.M.
Conference Description

This conference will address those new and innovative interventions, products and techniques whose implementation at the point of wounding (POW) will allow for a more stable and viable patient upon arrival at the tertiary facility and, hence, improved long-term outcome. Though originally designed for the military theater, Tactical Combat Casualty Care (TCCC) concepts are rapidly being adopted within the civilian medical and law enforcement communities as they are asked to respond to terror incidents at home. Columbine High School, Virginia Tech and terror incidents in Russia and India are only a few examples of the world in which we live. This conference is as relevant to law enforcement (local and federal) and medical first responders as it is to the Soldiers and Marines on the battlefield. It is also relevant to physicians, nurses and other care providers, both civilian and military, who have a need for familiarity with current medical care techniques in the tactical environment. (brochure)

When classes resume in the fall, the University of Maryland University College will be offering several courses in understanding terrorism, including "Counterterrorism" and "Terrorism, Antiterrorism and Homeland Security." Utah Valley University in Orem is looking for an assistant professor of emergency services. Clarkson University in Potsdam, N.Y., advertises that its environmental engineering majors will be equipped to tackle such frightening issues as global warming, acid rain and pollution. (more)

Maxim #1: TEMS is not "ATLS in the Field"

It would be easy to assume that as physicians specially trained in the field of emergency medicine, emergency medicine residents are already well versed in the actual "medical" components of TEMS. However, it is a naïve thought that just because we have run enough resuscitations, intubated enough patients, and put in enough chest tubes to be experts in advanced trauma life support (ATLS) and the management of critically ill patients, that we are fully prepared for medical emergencies in the tactical environment. (more)

Law enforcement is safer today than it was even as little as one decade ago. With strides in equipment, body armor, vehicle design, and safety tactics, to name a few, the profession has improved its ability to minimize officer injury and death. However, as the families of the more than 100 law enforcement professionals who died in the line of duty in 2009 will attest, the profession has not eliminated these risks altogether, and, hence, in this Year of Officer Safety at the IACP, it is imperative that officers be equipped with the knowledge and tools to mitigate and minimize the consequences of injuries when they occur. We can no longer afford to bury our heads and just strive for zero injuries. Until the profession achieves zero injuries, its members must prepare, and, to prepare, all must learn lifesaving skills. What has been limited historically to the tactical team medic or delegated to a civilian fire/rescue or EMS agency now must be delivered to the hands of each officer who has the potential for hostile contact. For this reason, the IACP presents the Saving Our Own (SOO) program and concept....more.

Alexander L. Eastman and Jeffrey C. Metzger, "Saving Our Own: The Ultimate Officer Safety Program," The Police Chief 77 (June 2010): 18-20, http://www.nxtbook.com/nxtbooks/naylor/CPIM0610/#/18(June 28, 2010).

Back-left to right - Richard A. "Doc" Clinchy, III Ph.D.-Board Member; Steve Giebner, MD, MPH-Board Secretary; John Croushorn, MD, FACEP-Board Treasurer; Ted Westmoreland-MEDMASH Moderator; Karl Plitt-Board Member

Front-left to right - Nelson Tang, M.D.-Board Member; Barbara Nicely-Executive Director; Jessica Perkins-Board Chair; Anne McKeague-Board Member; Corey Russ-Board Vice Chair (not shown) Dave Davis-Board Member

"The combined CTM board member skills and experience provide us with enormous industry insight and strength as well as invaluable non-profit leadership abilities" said board president Jessica Perkins. "The expertise brought to the table was apparent and the commitment to CTM, obvious. We know we have an enormous task ahead of us but I believe together we can achieve our mission," said Perkins.

As national threats grow the Coalition for Tactical Medicine (CTM)www.coalitiontacticalmedicine.org, a new, national non-profit will raise funds for scholarships to pay for tactical medical training and education for people who risk their lives daily. Local police, EMS, SWAT teams, and soldiers will be able to apply for scholarship funding. In addition, doctors, nurses, school principals and other non-traditional personnel who would also benefit from having tactical medical skills may be eligible. CTM's Mission: Strengthen the lifesaving capabilities of tactical medical providers worldwide. (more)