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INDEPENDENT ADvISOR’S REvIEw AND REPORT n 11

variety of administrative relationships within the representatives from 17 nations, agreed that an
U.S. Department of Defense (DoD) to establish NSOCM must be able to treat and sustain ca-
its current advisory position. The CoTCCC now sualties in an austere environment for 72 hours.
provides a forum for establishing standards of These casualties included both combat casualties,
practice not only for all components of U.S. DoD, addressed by TCCC standards, and additional
Coast Guard, and security agencies but also for illnesses that can affect mission success such as
many NATO and Allied armed forces. Dr. Butler respiratory infections, diarrheal illness, and ve-
explained that a strong contributor to CoTCCC’s hicular trauma. A number of prehospital curric-
credibility is the fact that a large percentage of com- ula, including PHTLS, address this wider scope
mittee members are point-of-wounding care pro- of medical pathologies. Dr. Norman McSwain
viders and that quarterly meeting agendas dedicate (USA), a PHTLS program founder, reviewed the
significant time to discussing contemporary case historical development of the PHTLS program’s
presentations from the active tactical environment. M-PHTLS branch. PHTLS added a military
chapter to its civilian manual in 1999 to address
The TCCC guidelines are updated quarterly and special considerations for military environments.
published on the U.S. Defense Health Board Mili- In 2003, the program published a full military
tary Health System, JSOM, and PHTLS websites. edition with its 5th edition of the civilian manual.
Many regard these guidelines as an international Both civilian and military manuals are scheduled
standard of practice for point-of-wounding care. for updating in 2015. Dr. McSwain highlighted
They are also published in the quarterly JSOM the special relationship between the M-PHTLS
and the U.S. National Registry of Emergency program and the CoTCCC. The CoTCCC, with
Medical Technicians (NREMT) PHTLS civilian its evidence-based approach and ties to current
and military textbooks. Both the NREMT and combat trauma experts, partners with the PHTLS
the American College of Surgeons (ACS) have en- editorial board to ensure that the M-PHTLS pro-
dorsed them. Dr. Butler demonstrated that NATO gram reflects the latest best practices in military
SOF has a common curricular substrate for point- medicine. The PHTLS/M-PHTLS curricula are
of-wounding healthcare, the TCCC guidelines, updated biannually, whereas TCCC guidelines
though this is not formalized in SOF doctrine. are reviewed and updated quarterly and published
Dr. Butler also expressed the CoTCCC’s desire to through websites. The PHTLS program manages
increase international contribution through com- a network of M-PHTLS instructors who receive
mittee membership participation. This would up-to-date TCCC guidelines as they are released.
capitalize on experiences and research being con-
ducted by Alliance partners. Finally, Dr. Butler Dr. McSwain summarized two general educational
reinforced the value of national senior political, models in current prehospital curricula: protocol-
military, and medical leadership support when based and principle-based curricula. Protocol-
implementing TCCC guidelines in U.S. Forces as based curricula tend to lessen the importance of
an important lesson learned for other nations try- understanding anatomy, physiology, and contrib-
ing to improve their national SOF systems. uting factors in favor of protocol-driven decision-
making processes. Proponents of protocol-based
3.2.3 Introduction to Military Prehospital curriculums cite uniformity of care across a system
Trauma Life Support (M-PHTLS ) and potential saved training time as benefits, since
®
The October 2011 NATO SOF Medical Con- students do not learn a foundational fund of knowl-
ference, sponsored by NSHQ and attended by edge, but instead memorize a series of protocols.