Casualties and Wounds
On the battlefield,
More and more countries are being pulled in to various types of internal and external wars.
What can a community Health worker do in theses situations?
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
The pre-hospital period is the most important time to care for any combat casualty.
In previous wars, up to 90 percent of combat deaths occurred before a casualty reached a medical treatment facility.
This highlights the primary importance of treating battlefield casualties at the point of injury, prior to casualty evacuation and arrival at a treatment facility.
Specifically, combat deaths result from the following:
• 31 percent: Penetrating head trauma.
• 25 percent: Surgically uncorrectable torso trauma.
• 10 percent: Potentially correctable surgical trauma.
• 9 percent: Exsanguination.
• 7 percent: Mutilating blast trauma.
• 3-4 percent: Tension pneumothorax (PTX).
• 2 percent: Airway obstruction/injury.
• 5 percent: Died of wounds (mainly infection and shock).
which means a commonsense approach and training everyone in the rudimentary skills of trauma care can at least save about 20 % of injured.
(Note: Numbers do not add up to 100 percent. Not all causes of death are listed. Some deaths are due to multiple causes.)
A significant percentage of these deaths (highlighted above in bold type) are potentially avoidable with proper, timely intervention.
Of these avoidable deaths, the vast majority are due to exsanguination and airway or breathing difficulties, conditions that can and should be addressed at the point of injury.
It has been estimated that of all preventable deaths, up to 90 percent of them can be avoided with the simple application of a tourniquet for extremity hemorrhage, the rapid treatment of a PTX(Tension pneumothorax ), and the establishment of a stable airway.
On the battlefield, casualties will fall into three general categories
: • Casualties who will die, regardless of receiving any medical aid.
• Casualties who will live, regardless of receiving any medical aid.
• Casualties who will die if they do not receive timely and appropriate medical aid.
TCCC addresses the third category of casualties — those who require the most attention of the medical provider during combat.
TCCC versus Advanced Trauma Life Support Trauma care training for military medical personnel traditionally has been based on the principles of the civilian Emergency Medical Technicians Basic Course and basic and advanced trauma life support (ATLS). These principles, especially ATLS, provide a standardized and very successful approach to the management of civilian trauma patients in a hospital setting. However, some of these principles may not apply in the civilian pre-hospital setting, let alone in a tactical, combat environment. The pre-hospital phase of casualty care is the most critical phase of care for combat casualties, accounting for up to 90 percent of combat deaths. Furthermore, combat casualties can suffer from potentially devastating injuries not usually seen in the civilian setting. Most casualties during combat are the result of penetrating injuries, rather than the blunt trauma seen in the civilian setting. Combat casualties may also suffer massive, complex trauma, such as traumatic limb amputation. In addition to the medical differences between civilian and combat trauma, several other factors affect casualty care in combat, including the following: • Hostile fire may be present, preventing the treatment of the casualty. • Medical equipment is limited to that carried by mission personnel.
• Tactical considerations may dictate that mission completion take precedence over casualty care. • Time until evacuation is highly variable (from minutes to hours or days). • Rapid evacuation may not be possible based on the tactical situation.
TCCC Goals TCCC presents a system to manage combat casualties that considers the issues discussed above. An important guiding principle of TCCC is performing the correct intervention at the correct time in the continuum of field care. To this end, TCCC is structured to meet three important goals: • Treat the casualty. • Prevent additional casualties. • Complete the mission. Stages of Care 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: • Care under fire is the care rendered at the point of injury while both the medic and the casualty are under effective hostile fire. The risk of additional injuries from hostile fire at any moment is extremely high for both the casualty and the medic. Available medical equipment is limited to that carried by the medic and the casualty. • Tactical field care is the care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by mission personnel. Time to evacuation may vary from minutes to hours. • 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 has been pre-staged in these assets should be available during this phase of casualty management. The chapters and sections of this handbook will present a discussion of each stage of TCCC as well as instructions for the procedures TCCC requires.
More and more countries are being pulled in to various types of internal and external wars.
What can a community Health worker do in theses situations?
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
The pre-hospital period is the most important time to care for any combat casualty.
In previous wars, up to 90 percent of combat deaths occurred before a casualty reached a medical treatment facility.
This highlights the primary importance of treating battlefield casualties at the point of injury, prior to casualty evacuation and arrival at a treatment facility.
Specifically, combat deaths result from the following:
• 31 percent: Penetrating head trauma.
• 25 percent: Surgically uncorrectable torso trauma.
• 10 percent: Potentially correctable surgical trauma.
• 9 percent: Exsanguination.
• 7 percent: Mutilating blast trauma.
• 3-4 percent: Tension pneumothorax (PTX).
• 2 percent: Airway obstruction/injury.
• 5 percent: Died of wounds (mainly infection and shock).
which means a commonsense approach and training everyone in the rudimentary skills of trauma care can at least save about 20 % of injured.
(Note: Numbers do not add up to 100 percent. Not all causes of death are listed. Some deaths are due to multiple causes.)
A significant percentage of these deaths (highlighted above in bold type) are potentially avoidable with proper, timely intervention.
Of these avoidable deaths, the vast majority are due to exsanguination and airway or breathing difficulties, conditions that can and should be addressed at the point of injury.
It has been estimated that of all preventable deaths, up to 90 percent of them can be avoided with the simple application of a tourniquet for extremity hemorrhage, the rapid treatment of a PTX(Tension pneumothorax ), and the establishment of a stable airway.
On the battlefield, casualties will fall into three general categories
: • Casualties who will die, regardless of receiving any medical aid.
• Casualties who will live, regardless of receiving any medical aid.
• Casualties who will die if they do not receive timely and appropriate medical aid.
TCCC addresses the third category of casualties — those who require the most attention of the medical provider during combat.
TCCC versus Advanced Trauma Life Support Trauma care training for military medical personnel traditionally has been based on the principles of the civilian Emergency Medical Technicians Basic Course and basic and advanced trauma life support (ATLS). These principles, especially ATLS, provide a standardized and very successful approach to the management of civilian trauma patients in a hospital setting. However, some of these principles may not apply in the civilian pre-hospital setting, let alone in a tactical, combat environment. The pre-hospital phase of casualty care is the most critical phase of care for combat casualties, accounting for up to 90 percent of combat deaths. Furthermore, combat casualties can suffer from potentially devastating injuries not usually seen in the civilian setting. Most casualties during combat are the result of penetrating injuries, rather than the blunt trauma seen in the civilian setting. Combat casualties may also suffer massive, complex trauma, such as traumatic limb amputation. In addition to the medical differences between civilian and combat trauma, several other factors affect casualty care in combat, including the following: • Hostile fire may be present, preventing the treatment of the casualty. • Medical equipment is limited to that carried by mission personnel.
• Tactical considerations may dictate that mission completion take precedence over casualty care. • Time until evacuation is highly variable (from minutes to hours or days). • Rapid evacuation may not be possible based on the tactical situation.
TCCC Goals TCCC presents a system to manage combat casualties that considers the issues discussed above. An important guiding principle of TCCC is performing the correct intervention at the correct time in the continuum of field care. To this end, TCCC is structured to meet three important goals: • Treat the casualty. • Prevent additional casualties. • Complete the mission. Stages of Care 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: • Care under fire is the care rendered at the point of injury while both the medic and the casualty are under effective hostile fire. The risk of additional injuries from hostile fire at any moment is extremely high for both the casualty and the medic. Available medical equipment is limited to that carried by the medic and the casualty. • Tactical field care is the care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by mission personnel. Time to evacuation may vary from minutes to hours. • 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 has been pre-staged in these assets should be available during this phase of casualty management. The chapters and sections of this handbook will present a discussion of each stage of TCCC as well as instructions for the procedures TCCC requires.
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