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

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.

Scope. a. USSOCOM’s principle function is to prepare SOF to carry out assigned missions. This responsibility is derived from US Code Title 10, Section 167. In addition to organizing, training, and equipping SOF for unique missions, medical education is fundamental to fulfilling this law. Title 10 explicit responsibilities include development of strategy, doctrine, tactics, conducting specialized courses of medical instruction for commissioned and non-commissioned officers, and monitoring the medical education and professional certification of officers and enlisted personnel. USSOCOM’s medical education and certification responsibilities are inherent responsibilities of developing strategy, doctrine and tactics. b. The Commander, United States Special Operations Command (CDRUSSOCOM) has the service- like responsibility of providing joint training and education venues that specialize in the art and science of joint Special Operations and its medical support. These efforts complete the education and training picture within the Department of Defense (DOD). While each of the Services, and the joint community, provide education and training to fill a particular niche (i.e., naval warfare, air warfare, joint warfare, etc.) the Joint Special Operations Medical Training Center (JSOMTC) within USSOCOM and the Air Force’s Pararescue (PJ) course provides training to fill the medical niche of joint SOF core task requirements. SOF medical training and certification is force-wide, designed to initiate, maintain, and/or enhance medical skills of those SOF medics and non-medics who are required to perform the unique, global, multi- discipline mission of USSOCOM. Within the parameters of this directive, as outlined by first reference (Glossary Section III), USSOCOM’s primary responsibility is the medical education and training and certification of SOF. A secondary responsibility is the training and education of select DOD, interagency, and international military personnel in the requirements, capabilities, and limitation(s) of joint special operations organizations. Fostering a mutual understanding ensures the proper application of SOF and the enhancement of joint, combined and interagency medical operations. General. In support of the Global War On Terrorism (GWOT), Special Operations medical personnel often find themselves providing care for both trauma and non-traumatic medical emergencies, beyond the Forward Edge of the Battlefield Area/Forward Line Of Troops, often in non-linear environments that may be far forward of any supporting medical infrastructure. This directive identifies the authority, mission, command relationships, functions, and responsibilities of the United States Special Operations Command as directed under Section 167, Title 10 of US Code to provide SOF medics with the required skill sets. In order to define and administer this SOF Medical skill set, USSOCOM has established a SOF Emergency Medical Services (EMS) State that is administered by the Command Surgeon. Medics who successfully complete the required academic requirements as defined within this directive will thus be known as SOF Advanced Tactical Practitioners (ATP).

The Combat Medic of today is the most technically advanced ever produced by the United States Army. Such an advanced technician requires an advanced teaching and learning system. 68W Advanced Field Craft is the first textbook designed to prepare the Combat Medic for today’s challenges in the field. The ability to save lives in war, conflicts, and humanitarian inventions requires a specific skill set. Today’s Combat Medic must be an expert in emergency medical care, force health protection, limited primary care, evacuation, and warrior skills. 68W Advanced Field Craft combines complete medical content with dynamic features to support instructors and to prepare Combat Medics for their missions.

A decade of intense combat in two theaters has taught us many lessons about what works and what does not in the effort to accomplish that all-important mission of saving lives in battle. A severely injured Soldier today has about twice the likelihood of surviving his wounds compared to Soldiers in wars as recent as Vietnam. That progress is the result of many things: better tactics and weapons, better body armor and helmets, better trained and fitter Soldiers. But, the introduction of tactical combat casualty care (TCCC) throughout the Army has certainly been an important part of that improvement. TCCC is fundamentally different from civilian care. It is the thoughtful integration of tactics and medicine, but to make it work takes a different set of skills and equipment, and every Soldier and leader needs to understand it and practice it. This handbook is the result of years of careful study of the care of wounded Soldiers, painstaking research by medics and physicians, and the ability of leaders at all levels to see and understand the lessons being learned and the willingness to make the changes in equipment, training, and doctrine needed to improve the performance of the Army Health System. It is the best guidance we have at the time of publication, but new information, new techniques, or new equipment will drive changes in the future. Be assured that these performance improvement efforts will continue as long as American Soldiers go in harm’s way.

INTRODUCTION: What is TCCC and Why Do I Need to Learn about it?? 1. Coalition forces presently have the best casualty treatment and evacuation system in history. 2. TCCC is what will keep you alive long enough to benefit from it. 3. Originally a Special Operations research effort Trauma management plans that take into account the unique challenges faced by combat medical personnel Now used throughout U.S. military and by most allied countries TCCC has helped U.S. combat forces to achieve the highest casualty survival rate in history. TCCC Approach: 1. Identify the causes of preventable death on the battlefield 2. Address them aggressively 3. Combine good medicine with good tactics Phases of Care in TCCC: 1. Care Under Fire Care under fire is the care rendered by the first responder or combatant at the scene of the injury while he and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the individual or by the medical provider in his or her aid bag. 2. Tactical Field Care Tactical Field Care is the care rendered by the first responder or combatant once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred, but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by unit personnel. Time to evacuation to a medical treatment facility may vary considerably. 3. 3. Tactical Evacuation Care Tactical Evacuation Care is the care rendered once the casualty has been picked up by an aircraft, vehicle or boat. Additional medical personnel and equipment that may have been pre-staged should be available in this phase of casualty management.

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.