AAR from Sanjay J (Tactical Combat Casualty Care (TCCC) Training)

  In 1996, an article had been published as a supplement to the Journal of Military Medicine titled: Tactical Combat Casualty Care in Special Operations. It identified the difference between pre-hospital trauma care in the civilian world and pre-hospital trauma care at the point of injury on the battlefield.[1] Not long afterwards in 1998, Commander of the 75th Ranger Regiment, then COL Stanley McChrystal, placed a directive for all Rangers to focus on four priorities, one of which was medical training. [2]The 3/75 Ranger Battalion Aid Station took note and identified that the Army’s basic medical training course, Combat Lifesaver (CLS) course, spent much time covering slow rolling preventive medical concerns and lacked emphasis on trauma patients: massive extremity hemorrhage, tension pneumothorax, and airway obstruction. [3]

            The infamous Battle of Mogadishu gave notice to a requirement to update casualty assessment and rapid treatment of patients sustaining gunshot wounds. Ranger First Responder Course was not seen as a replacement to CLS, but an added spin for the Rangers to develop a much more rapid casualty assessment and treatment of trauma patients on the battlefield. It was designed to take Non-Medic MOS and advanced them to be additional medical support on the battlefield. The course covered many topics to include the following: preventative medicine, casualty assessment, assessment and management of airway; assessment of circulation; rapid trauma assessment; and detailed physical examination/ongoing assessment.[4] I was fortunate enough to be a student in that first course at 3/75.

            Today, the RFR is a program of instruction that incorporates TCCC guidelines and protocols which focus on the care of casualties in a combat or tactical environment at the point of injury.[5] It prepares non-medic Rangers to provide self-aid or buddy-aid in the absence of a medical provider. Unlike most one or two day courses, RFR  is a 40-hour or five day course. TCCC course at most military installations is approximately three days. Green OPS TCCC course is a scaled down version designed to teach students equipped with IFAK type kits to control bleeding as well as the following: airway management; identify and treat for shock; identify tension pneumothorax; prevent casualty from hypothermia; and prepare casualty for evacuation.

            The Green OPS Inc. Tactical Combat Casualty Care (TCCC) Training was hosted in the facilities of F3 Tactical on 05 October 2019. The Instructor, Sergeant Major Michael Chavaree, former 3/75 Ranger Medic comes from a lineage of where combat medical readiness and training has exceeded the Army’s basic Combat Lifesaver (CLS) course. With several deployments under his belt as a Special Operations Medic, he currently works at the Army Medical Command (MEDCOM). The course required all students to bring at the minimum their Individual First Aid Kit (IFAK). Most familiar with the IFAK terminology from the military and civilian sector understood the contents of the kit. Prior to starting the class, Mike walked by and conducted a thorough examination of all kits, identifying any shortfalls. However, one could infer that he was determining the level of medical experience by way of its content and how kits were assembled.

            Following introductions by the class, Mike began by providing the different levels of TCCC training by way of audience: 1. All Services; 2. Tier two– CLS and above; 3. Combat Medics; and Special Operations Medics. Mike identified that hemorrhage was the still largely the largest contributing factor to deaths. He identified the three types of casualty care provided: 1. Care Under Fire; Tactical Field Care; and Tactical Evacuation Care. The course went in blocks of 60 min supplemented with a 5-10 min break.

            Demonstrations were provided with the following tourniquets: Combat Application Tourniquet (CAT), SOF-T, and with my RATS tourniquet.  Discussions led into the pros/cons of each. Students paired up to monitor one another for proper application during class. Throughout the day Mike would yell out ‘put em’ on’ to test our ability to minimize the time required for self application. The drill not just tested a student’s ability to apply a tourniquet, but stressed the importance of getting it done correctly the first time. Our student ratio was very small, eight with two observers. Ironically, there were no law enforcement personnel identified in the course. F3 Tactical’s facility was able to accommodate the class size. A big thanks to them for holding this training venue.

Observations:

            First, TCCC traning has changed the order of battled with regards to casualty assessment. For those personnel who have attended Combat Lifesaver, conducting the ABC’s of casualty assessment, has been changed with priority to the bleeder. This is where Mike’s class takes the average person (non-military) and teaches them how to effectively extend a patients life long enough for a trained medical professional to take over. This brings up the next point.

            Second, practice and training for casualty assessment is a must for non-medical personnel, like myself. I look at it very similar to dry-fire training. In addition to doing preventative checks on all medical gear, students must utilize a practice kit in order to be proficient if/when the requirement exists. Therefore, if more time could be added this course, my vote would be for a more thorough casualty assessment.

            Third, the size of the classroom may hinder future training with more participants. Re-configuring the working space would allow more students, but may hinder some form of a trauma lane.  Since this course was to my knowledge the first TCCC course sponsored by Green OPS, I anticipate the demand signal could potentially drive this into a two day course with options for trauma lanes.

            Lastly, getting even Ft. Belvoir to hold a TCCC course is an enduring task. I am very thankful to Sergeant Major Michael Chavaree, Chris Alvarez of Green OPS, & Jimmy of F3 Tactical for holding this course.

Respectfully,

Sanjay J

Rangers Lead The Way!

[1]“Fort Benning.” Fort Benning | 75th Ranger Regiment. Accessed October 12, 2019. https://www.benning.army.mil/Tenant/75thRanger/Medical-Training.html.

[2]“Fort Benning.” Fort Benning | 75th Ranger Regiment. Accessed October 12, 2019. https://www.benning.army.mil/Tenant/75thRanger/Medical-Training.html.

[3]“Fort Benning.” Fort Benning | 75th Ranger Regiment. Accessed October 12, 2019. https://www.benning.army.mil/Tenant/75thRanger/Medical-Training.html.

[4]Boswell, Clifford. "Ranger First Responder" Class lecture, 3rd Battalion Aid Station, 75 Ranger Regiment, Fort Benning, VA, July7, 1999

[5]“Fort Benning.” Fort Benning | 75th Ranger Regiment. Accessed October 12, 2019. https://www.benning.army.mil/Tenant/75thRanger/Medical-Training.html.