Tactical Combat Casualty Care (TCCC) has saved hundreds of lives during our nation's conflicts in Iraq and Afghanistan. Nearly 90 percent of combat fatalities occur before a casualty reaches a medical treatment facility. Therefore, the prehospital phase of care is needed to focus on reducing the number of combat deaths. However, few military physicians have had training in this area and, at the onset of hostilities, most combat medics, corpsmen, and pararescue personnel in the U.S. military have been trained to perform battlefield trauma care through civilian-based trauma courses. These courses are not designed for the prehospital combat environment and do not reflect current practices in the area of prehospital care. TCCC was created to train Soldiers and medical personnel on current best practices for medical treatment from the point of injury to evacuation to Role 3 facilities.

Over 380 total pages ... 1. FULL TITLE: U.S. SPECIAL OPERATIONS COMMAND's TACTICAL TRAUMA PROTOCOLS (TTPs) TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) RECOMMENDED DRUG LIST (RDL) CANINE TACTICAL COMBAT CASUALTY CARE For SPECIAL OPERATIONS ADVANCED TACTICAL PARAMEDICS (SO-ATPs) - December 2016 CONTENTS By SECTION: SECTION 1: TACTICAL TRAUMA PROTOCOLS SECTION 2: TACTICAL MEDICAL EMERGENCY PROTOCOLS SECTION 3: RECOMMENDED DRUG LIST SECTION 4: CANINE COMBAT CASUALTY CARE (C-TCCC) SECTION 5: BURN QUICK REFERENCE GUIDE SECTION 6: NERVE CHARTS 2. FULL TITLE: Tactical Combat Casualty Care Handbook, Version 5 - May 2017 CONTENTS By CHAPTER: Chapter 1. Tactical Combat Casualty Care Overview Chapter 2. Tactical Combat Casualty Care Phases of Care Chapter 3. Tactical Combat Casualty Care Medical Equipment Chapter 4. MARCH/PAWS Treatment Algorithms Chapter 5. Tactical Combat Casualty Care-All Combatants Chapter 6. Tactical Combat Casualty Care-Medical Provider Appendix A. Tactical Combat Casualty Care Card Appendix B. Tactical Combat Casualty Care After Action Report Appendix C. Medical Triage Categories Appendix D. Medical Evacuation Precedence Categories Appendix E. 9-Line Request With MIST Report Appendix F. Prolonged Field Care Appendix G. Drug Reference Guide Appendix H. Medical Transition Guidelines in a Tactical Environment Appendix I. Medical Planning Functions Appendix J. Tactical Combat Casualty Care Background Appendix K. References

CONTENTS: Tactical Combat Casualty Care Guidelines for Medical Personnel 03 June 2016 COMBAT LIFESAVER / TACTICAL COMBAT CASUALTY CARE STUDENT HANDOUT (2014) COMBAT LIFESAVER / TACTICAL COMBAT CASUALTY CARE STUDENT HANDOUT (2017) COMBAT LIFESAVER / TACTICAL COMBAT CASUALTY CARE TRAINER COURSE STUDENT HANDBOOK - Combat Lifesaver / Tactical Combat Casualty Care Instructor Course (2014) COMBAT LIFESAVER / TACTICAL COMBAT CASUALTY CARE TRAINER COURSE STUDENT HANDBOOK - Combat Lifesaver / Tactical Combat Casualty Care Instructor Course (2017) CASUALTY EVALUATION AND EVACUATION STUDENT HANDOUT PREVENTION AND TREATMENT OF FIELD RELATED INJURIES B151236 STUDENT HANDOUT COMBAT LIFE SAVING STUDENT HANDOUT

Over 2,300 total pages ... OVERVIEW Tactical Combat Casualty Care (TCCC) was developed to emphasize the need for continued improvement in combat pre-hospital care. The Committee on Tactical Combat Casualty Care (CoTCCC) was established in 2001 and is part of the Defense Health Board. CoTCCC is a standing multi-service committee charged with monitoring medical developments in regards to practice, technology, pharmacology and doctrine. New concepts in hemorrhage control, airway management, fluid resuscitation, analgesia, antibiotics and other lifesaving techniques are important steps in providing the best possible care for our Marines and Sailors in combat. The TCCC guidelines are published every 4 years in the Prehospital Trauma Life Support manual. It has been recognized that TCCC guidelines and curriculum will need to change more often than the 4-year cycle of the PHTLS textbook publication. The National Association of Emergency Medical Technicians (NAEMT) will include the updated TCCC guidelines and curriculum on its website as they are approved as a way to help get this new information out to the combat medical personnel in the military that need it. PRINCIPLES OF TACTICAL COMBAT CASUALTY CARE (TCCC) The principles of Tactical Combat Casualty Care are fundamentally different from those of traditional civilian trauma care, where most medical providers and medics train. These differences are based on both the unique patterns and types of wounds that are suffered in combat and the tactical conditions medical personnel face in combat. Unique combat wounds and tactical conditions make it difficult to determine which intervention to perform at what time. Besides addressing a casualty’s medical condition, responding medical personnel must also address the tactical problems faced while providing care in combat. A medically correct intervention at the wrong time may lead to further casualties. Put another way, “good medicine may be a bad tactical decision” which can get the rescuer and the casualty killed. To successfully navigate these issues, medical providers must have skills and training oriented to combat trauma care, as opposed to civilian trauma care. The specifics of casualty care in the tactical setting will depend on the tactical situation, the injuries sustained by the casualty, the knowledge and skills of the first responder, and the medical equipment at hand. In contrast to a hospital Emergency Department setting where the patient IS the mission, on the battlefield, care of casualties sustained is only PART of the mission. TCCC recognizes this fact and structures its guidelines to accomplish three primary goals: 1. Treat the casualty 2. Prevent additional casualties 3. Complete the mission In thinking about the management of combat casualties, it is helpful to divide care into three distinct phases, each with its own characteristics and limitations.

68W Healthcare Provider JOB BOOK This book is designed to help you in maintaining accountability of your training, performance of skills and continuing education requirements for recertification as a Nationally Registered Emergency Medical Technician - Basic. This job book is required to be with you while in the performance of your duties. This will allow senior medical personnel to fill in areas when skills or training have been performed or completed. This will allow you the greatest opportunity for success when it is time to recertify your certification. This is a tool for you to remain successful while as a 68W. Good luck and enjoy your time as an Army Medic! "Trained to Save" Training Support Package Contents: Introduction Terminal Learning Objective - Perform Tactical Combat Casualty Care Presentation Enabling Learning Objective A - Describe Care Under Fire, Tactical Field Care, and Tactical Evacuation Care Enabling Learning Objective B - Identify items used in first aid. Enabling Learning Objective C - Perform Care under Fire Enabling Learning Objective D - Perform Tactical Field Care Enabling Learning Objective E - Perform Tactical Evacuation Care Enabling Learning Objective F - Initiate a Field Medical Card and TCCC Card

Written by Dianne Inglis and Jeffrey Kenneally, the workbook includes more than 70 paramedic-focused clinical skills that link underpinning theory and knowledge with expectations for contemporary clinical practice. To ensure the skills are performed correctly and to standard, the resource is further strengthened with a ready-made assessment tool, ideal for both self-directed learning and instructor use. The text is designed for practising skill development, and preparation for assessment and clinical placement. Clinical Skills for Paramedic Practice 1e includes two key components: practical skill instruction and the Objective Structured Clinical Examination (OSCE) assessment checklist. The skills sections contain clear step-by-step written and photographic instruction in basic to advanced clinical skills, with rationales provided to enhance knowledge acquisition and clinical decision-making. The OSCE checklists allow students and instructors to easily track and assess progress in skill development. Step-by-step skill instruction combined with an OSCE assessment checklist Structured reflection and end-of-chapter questions to assist with deeper understanding of key concepts and application to practice Designed specifically for use by Australian and New Zealand paramedics An eBook and downloadable skill and assessment sheets are included with purchase of the print book Additional resources on Evolve: • An eBook on VitalSource Student and Instructor Resources on Evolve: Clinical skill work instructions Formative Clinical Skill Assessment (F-CSAT) Summative Clinical Skill Assessment (S-CSAT) Performance Improvement Plan (PIP) Formative Clinical Skill Assessment (F-CSAT) key Direct Observation of Procedural Skills (DOPS)

Tactical Combat Casualty Care Guidelines 28 October 2013 * All changes to the guidelines made since those published in the 2010 Seventh Edition of the PHTLS Manual are shown in bold text. The most recent changes are shown in red text. * These recommendations are intended to be guidelines only and are not a substitute for clinical judgment. Basic Management Plan for Care Under Fire 1. Return fire and take cover. 2. Direct or expect casualty to remain engaged as a combatant if appropriate. 3. Direct casualty to move to cover and apply self-aid if able. 4. Try to keep the casualty from sustaining additional wounds. 5. Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process. 6. Airway management is generally best deferred until the Tactical Field Care phase. 7. Stop life-threatening external hemorrhage if tactically feasible: - Direct casualty to control hemorrhage by self-aid if able. - Use a CoTCCC-recommended tourniquet for hemorrhage that is anatomically amenable to tourniquet application. - Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.

BACKGROUND IN 1996, THE NAVAL SPECIAL WARFARE COMMAND DEVELOPED A NEW SET OF TACTICALLY APPROPRIATE BATTLEFIELD TRAUMA CARE GUIDELINES NAMED TCCC. THE TCCC GUIDELINES WERE ADOPTED BY THE U.S. SPECIAL OPERATIONS COMMAND (USSOCOM) AND APPROVED BY THE AMERICAN COLLEGE OF SURGEONS (ACS) AND THE NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS. THE COMMITTEE ON TCCC WAS ESTABLISHED IN 2001 AND WAS DIRECTED TO FURTHER DEVELOP THE TCCC STANDARDS AND GUIDELINES. THE COMMITTEE ON TCCC FUNCTIONS AS A WORKING GROUP OF THE TRAUMA AND INJURY SUBCOMMITTEE OF THE DEFENSE HEALTH BOARD (DHB), WHICH HAS A CHARTER TO PROVIDE MEDICAL RECOMMENDATIONS TO ASD (HA) AND THE SERVICE SURGEONS GENERAL. TCCC CONCEPTS WERE INCORPORATED INTO THE 8404 CORPSMAN TRAINING CURRICULUM IN 2005. THE TCCC/CLS TRAINER COURSE WAS DEVELOPED IN 2006 TO PROVIDE CORPSMEN AS TRAINERS TO TEACH AND SUSTAIN TCCC STANDARDS TO CORPSMEN AND CLS SKILLS TO SELECTED MARINES WITHIN THE OPERATING FORCES. THE IMPLEMENTATION OF TCCC ACROSS ALL SERVICES HAS BEEN IDENTIFIED AS ONE OF THE CONTRIBUTING FACTORS TO THE HIGHEST COMBAT CASUALTY SURVIVAL RATES IN HISTORY AND IS RECOMMENDED BY ASD (HA) FOR USE WHEN TRAINING COMBAT MEDICAL PERSONNEL, REF B. TCCC INFORMATION IS PUBLISHED IN THE PREHOSPITAL TRAUMA LIFE SUPPORT MANUAL (PHTLS), MILITARY EDITION, WHICH IS UPDATED EVERY FOUR YEARS. DEPARTMENT OF DEFENSE (DOD) APPROVED TCCC TRAINING CURRICULA ARE UPDATED ON THE DOD WEBSITE MHS.OSD.MIL/EDUCATION AND TRAINING/TCCC.ASPX AS THE TCCC GUIDELINES CHANGE. GOAL. ELIMINATE PREVENTABLE LOSS OF LIFE ON THE BATTLEFIELD. IN ACCOMPLISHING THIS GOAL, THE MOST RECENT TCCC GUIDELINES APPROVED BY DOD ARE TO BE UTILIZED AS A MEANS OF PROVIDING STANDARDIZED TRAINING TO THE MARINE CORPS AND IMPROVING FIRST RESPONDER CARE AT THE POINT OF INJURY. HISTORY OF TCCC: a. It is important to realize that civilian trauma care in a non-tactical setting is dissimilar to trauma care in a combat environment. TCCC and CLS are an attempt to better prepare medical and non-medical personnel for the unique factors associated with combat trauma casualties. b. Historical data shows that 90% of combat wound fatalities die on the battlefield before reaching a military treatment facility. This fact illustrates the importance of first responder care at the point of injury. c. TCCC was originally a US Special Operations research project which was composed of trauma management guidelines focusing on casualty care at the point of injury. d. TCCC guidelines are currently used throughout the US Military and various allied countries. e. TCCC guidelines were first introduced in 1996 for use by Special Operations corpsmen, medics, and pararescue (PJs). f. The TCCC guidelines are currently endorsed by the American College of Surgeons, Committee on Trauma and the National Association of Emergency Medical Technicians. The guidelines have been incorporated into the Prehospital Trauma Life Support (PHTLS) text since the 4th edition. STUDENT CURRICULUM: Tactical Combat Casualty Care/CLS Overview Identify Medical Fundamentals Manage Hemorrhage Maintain Casualty Airway Manage Penetrating Chest Injuries Manage Hemorrhagic Shock Manage Burn Casualties Perform Splinting Techniques Administer Battlefield Medications Perform Casualty Movement Perform Combat Lifesaver Triage Perform Combat Lifesaver Care

Whether you’re a newcomer to the ICU or a seasoned practitioner, Oh's Intensive Care Manual delivers the practical, expert answers you need to manage the conditions you see every day in the intensive care unit. This highly esteemed, bestselling medical reference book presents comprehensive detail on each topic, while maintaining a succinct, accessible style so this information can be seamlessly incorporated into your daily practice. Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Access everything you need to know about disease processes and their management during the course of ICU rotations. Gain valuable insight into the consensus of practice and standard of ICU care as followed in the UK, Europe, India, and Australia. Take advantage of expert advice on practical issues that will be encountered on a day-to-day basis in the ICU, as well as common pitfalls in treatment and management emphasized in each chapter. Overcome the latest challenges in intensive care medicine. Ten brand-new chapters in this edition include: Palliative Care; ICU and the Elderly; Health Care Team in Intensive Care Medicine; Preparing for Examinations in Intensive Care Medicine; Ultrasound in the ICU; ECMO for Respiratory Failure; ECMO for Cardiac Failure; Cirrhosis and Acute-on-Chronic Liver Disease; Solid Tumours and their Implications in the ICU; and Delirium. Optimize patient outcomes through an even greater focus on clinical management strategies. Quickly locate essential information with an increased number of summary boxes, tables, and charts, and a new chapter organization that expedites reference.

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