ZEMUNIK AIR BASE AT ZADAR, Croatia (Army News Service, June 16, 2011) -- With more and more European partner nation special operation forces participating in International Security Assistance Force operations, having medical personnel available to save the lives of wounded personnel is of critical importance.
Medical personnel, regardless of nation, must be trained in and armed with the appropriate medical equipment and procedures corresponding to each level of care and perform to the same standards.
Too meet that standard, the U.S. Special Operations Command Europe, or SOCEUR, developed and conducted a Tactical Combat Casualty Care "train-the-trainer" course to enhance the Special Operations Forces, or SOF, capability and interoperability of the participating nations, but most importantly, to incorporate one, recognized standard for managing trauma on the battlefield.
Over a two-week period here in May, 17, 2011, medics from Croatia, Germany, Hungary, Latvia, Lithuania, Romania and Ukraine received expanded medical and trauma care training from U.S. medical personnel from 1st Battalion, 10th Special Forces Group and 352nd Special Operations Group.
According to Lt. Col. Mark Ervin, a SOCEUR Surgeon, after feedback from several multinational events and deployments that SOCEUR components participated in, it was clear that while all the participants were familiar with the principles taught as part of Tactical Combat Casualty Care, or TCCC, there were differences in how those principles were applied.
"These differing standards led to less effective care when the injured combatant most needed rapid medical treatment," Ervin said.
SOCEUR's goal in organizing the TCCC train-the-trainer course was to provide its partner nation SOF medics with the knowledge and skills required to instruct others in providing medical care in a combat environment, following the guidelines and protocols of TCCC.
Although TCCC started as an initiative by U.S. Special Operations Command, it is now used by all services in the U.S. military, conventional as well as SOF community. It is also now used by most allied countries and has been credited as a major factor in U.S. forces having the highest casualty survival rate in history, according to United States Army Institute of Surgical Research.
"This event gave a multinational group of experienced combat trauma care instructors a common course of instruction approved by the official internationally recognized committee on TCCC," Ervin said. "This regularly updated and reviewed program can now be used to bring all SOF operators and medics into compliance with an internationally recognized standard."
The initial proposal to conduct the course took place in October 2010 where members of the SOCEUR medical directorate briefed the Croatian Ministry of Defense on the concept of the TCCC and presented a formal request to conduct the event there. Over a five-month period, several planning conferences took place to gather input from the partner nations and to establish a common framework for the event.
"When we first starting discussing TCCC training with our partner nations, it became clear that certification from an internationally recognized body was critically important," Ervin said. "We entered discussions with the Committee on Tactical Combat Casualty Care, which resulted in defined criteria for approval of international TCCC courses to be certified by the CoTCCC and the naming of two experienced TCCC instructors based in Europe to serve as validating officials."
The CoTCCC's mission is to advise the Assistant Secretary of Defense for Health Affairs and the surgeons general of the services about battlefield trauma care for wounded warriors. The committee is responsible for making changes and updates to the TCCC program.
The training objectives of the SOCEUR-sponsored event centered on the three definitive phases of TCCC.
The first of the three is care under fire -- which includes care rendered at the scene of the injury, while both the medic and the casualty are under hostile fire. In such a situation, available medical equipment is limited to that carried by each operator and the medic.
Tactical field care is the second objective. This care is rendered once the casualty is no longer under hostile fire. In this case, medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours.
The third objective, tactical evacuation care, is rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.
Training objectives included tourniquet application, hemorrhage control, needle decompression, patient movement, splinting, nasopharyngeal airway insertion, MEDEVAC request and rotary wing loading procedures. The participants were also required to be able to evaluate each other, design their own scenarios, and perform other instructor skills so that they would be able to return to their own units and teach what they had learned.
Ervin specifically highlighted the importance of having interoperable protocols for tactical field medical care, as wounded personnel may likely be treated by medical personnel from a different nation.
"With the diverse coalition contributing to ISAF, it is possible that a casualty will be seen by a combat first responder, medic, casualty evacuation crew and physician that all come from different countries," Ervin said. "A standardized protocol of field trauma care, such as TCCC, assures the injured combatant that despite the differences in language, everyone caring for him will be able to perform the most appropriate procedures and communicate using the 'language' of TCCC."
As a lead instructor of the event, Master Sgt. Will A. Ward, noncommissioned officer in charge of medical operations, 352nd SOG, used his prior TCCC training to bring an air of realism to the participants. Ward especially included "stress inoculation" as part of the field training exercise. The concept of stress inoculation is derived from a common principle in TCCC which is, care on the battlefield is almost never under good conditions.
During the field training exercise, or FTX, the participants were exposed to stressful factors that could influence battlefield casualty care. Such factors included darkness, terrain, limited medical equipment, evacuation times, and enemy fire -- the number one factor that determines when and how much care can be provided. Participants also underwent several training lanes in which they were evaluated for their ability to make timely life-care decisions under duress.
"Exposing students to a 'stressful' environment while making them follow the guidelines and theories of TCCC is the only real way to see if they can follow those guidelines while dealing with what could be a very difficult tactical situation," Ward said.
Ward pointed out that most battlefield casualty scenarios involve making both medical and tactical decisions very rapidly -- so placing the medics in situations where their decisions would be the difference between life and death added to their stress level.
"I really wanted to focus on giving the partner nations the same quality and level of training that we get for our initial training," Ward said. "This includes the same intensity in the exercises. I remember the first time that I had to perform TCCC guidelines in the dark, in a room simulating aircraft sound, temperature controlled at 105 degrees, and with an instructor who was more than happy to 'hurry me along' if I was going too slow. Those lessons helped when I had to perform in theater, so I want to impart that on them."
As the host of the TCCC course, Maj. Mladen Gavrich, chief of Medical Department, Croatian Special Operations Forces Battalion, was very impressed with the degree of training the medics underwent.
Recognizing that regardless of the subject matter expertise and experience of his own nation's medics had prior to attending the course, Gavrich said the TCCC brought a new dimension to casualty care training that the Croatians had never experienced.
"We've never trained like this before, especially placing our medics in stressful conditions," Gavrich said. "The training gave our medics a realistic picture of what could go right or wrong when treating a casualty on the battlefield -- especially when taking fire (at the same time) someone ... is depending on them to keep them alive."
He added that with future deployments of the Croatian SOF in support of ISAF, the TCCC course provides a valuable resource and important skills for medics to be successful while providing this type of medical care to wounded troops on the ground when needed.
Most importantly, Gavrich stressed the course lays a foundation for future medical training as the Croatians will implement their own TCCC course later this year, "taught with common standards and guidelines of the NATO community."
"The knowledge of what they gained here will allow us to develop better and quality training for our soldiers," he said. "I look forward to seeing how our instructors will train our medics with the skills that they take back from this training. I can say that the TCCC brings our combat medical care to a higher level."
Ervin agreed with Gavrich's conclusion on the importance of the TCCC in developing more qualified medics and also said that linking the event to the CoTCCC provides a continuity of updated training requirements that all the nations can maintain.
"This committee regularly updates the curriculum based on battlefield evidence from trauma casualties," Ervin said. "The NATO SOF Headquarters Medical Advisors Office, who coordinated CoTCCC support for this event, is the link between these newly minted NATO TCCC trainers and the CoTCCC."
For one of the training participants, the TCCC course proved very beneficial. A Lithuanian Special Forces medic, with three combat tours in Afghanistan, mentioned that although his medical standards were similar to the Americans, it was very important to have one standard for all NATO countries serving together in a coalition capacity.
"If we start to train repetitiously according to the TCCC model, we will be able to better save lives," the medic said. "This course brings legitimacy to the direction we want to go when developing our special forces operators and medics to perform the TCCC protocols to the international standard. We will also take those same standards to better develop our conventional forces."
He specifically stressed the importance of knowing what actions to take when under enemy fire.
"This course allowed me to think what my actions are when in combat and treating a casualty," the medic said. "All of my medics understand first aid, but they must be able to think quickly (about) when to engage the enemy on the battlefield and also be able to provide care while under fire."
Having met SOCEUR's short-term goal of providing an internal mechanism for partner nation SOF to train their own forces in the life-saving battlefield skills to the level of the international standard, Ervin said the way ahead for SOCEUR was to maintain the momentum of the TCCC event.
"Long term, this is the first step in the development of an international cadre of TCCC instructors that will provide NATO SOF greater interoperability in field trauma care," Ervin said. "Ultimately, we expect the employment of the TCCC standard within NATO will drive the introduction of the best European combat trauma scientific research into the proceedings of the CoTCCC."
Related Links:
STAND-TO!: Enhancing International Security Assistance Force Preparation
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