Background of TCCC

Originating within the Navy SPECWAR community in the mid-90s, the Tactical Combat Casualty Care (TCCC) is a set of guidelines based on phased care on the battlefield based on activity and threat level. Designed from the onset specifically for SOCOM units, to reduce the mortality and morbidity sustained on the battlefield, it has since grown to all branches of the conventional US military as well as into civilian medicine and foreign militaries. 

Controlling the future path of TCCC, based on real-world experience and evidence-based medicine, is the Committee on Tactical Combat Casualty Care (CoTCCC). CoTCCC is a 42-member group under the Defense Health Agency, consisting of enlisted and commissioned members of all branches of the military who develop and revise the guidelines which encompass TCCC. 100% of the membership have downrange experience in a combat setting, treating traumatic injuries sustained on the battlefield. 

TCCC in the Military

Since the start of the Global War on Terror in 2001, TCCC has slowly been pushed out from the SOCOM realm, into the hands of conventional units, culminating in DoD Instruction 1322.24, in March of 2018. This instruction mandates TCCC training for all active duty service members every three years, regardless of role. 

This means that every deploying service member will have received TCCC tailored to skillset (medic/Corpsman versus non-medical personnel). Training for this has started to roll out throughout the Department of Defense and will soon be integrated into lower-level training such as boot camp/basic training. 

TCCC in the Navy Hospital Corps

Under Navy Medicine, is the Naval Expeditionary Medical Training Institute (NEMTI). NEMTI’s mission is “To provide innovative and multi-faceted expeditionary training and auxiliary support to DoD personnel in support of joint medical operations worldwide”. Under NEMTI, is training for personnel deploying in support of Role I, II, and III medical facilities, fleet surgical teams, and all TCCC training. This includes all expeditionary medical training conducted by the US Navy or US Marine Corps. All TCCC curriculum taught at any Navy or Marine Corps command comes directly from NEMTI. 

Currently, the first exposure a Corpsman will receive to TCCC is in the last few weeks of Corpsman “A-School”, or the entry-level training administered to Corpsman before they’re sent to their first unit. The TCCC curriculum consists of two days didactic, and two days practical, with the fifth day comprised of a 20-minute patient assessment and treatment exercise. This course is in line with other Navy TCCC curriculum. 

Field Medical Training Battalion (FMTB), are two commands, East and West, that are located at Camp Lejeune and Camp Pendleton. FMTB runs the Field Medical Service Technician (FMST), which consists of 2 months of TCCC and USMC familiarization, culminating in a week of field exercises designed to test the students in patrolling, land navigation, IED detection, basic squad maneuvers, and TCCC. FMST is the basic course required of Corpsman going to billets with the Marine Corps. The course curriculum is set by FMTB and cleared through NEMTI. 

Cefotetan, a broad-spectrum antibiotic initially in the TCCC guidelines, was withdrawn from the guidelines in the 2017 update pushed out by CoTCCC. As of the time of this writing (August 2019), it was still being taught to Corpsman attending FMST. Additionally, MARCH-PAWS, the pneumonic used in TCCC as the guideline order in which to assess the patient, was implemented in 2017-2018. MARCH-PAWS itself has been in use with AFSOC PJ’s since at least 2012 and increases recognition and treatment of wounds over the older pneumonic, PMARCHP. PMARCHP was still the algorithm of choice by NEMTI up until around July of 2019. 

Currently, the Army requires their 68W’s (healthcare specialists, equivalent to Navy Corpsmen) to attend “Table 8’s”, their version of sustainment training, yearly. Within “Table 8’s”, is 5 days of TCCC. Contrary to the Army, Navy Corpsmen are only required to do sustainment training every 2 years, and it does not include TCCC. A stand-a-lone, 5 day, TCCC course is required by all Corpsman every 3 years, or 180 days prior to deployment. 

Advanced Tactical Medicine

With the possibility of the next major war the United States wages being at the peer or near-peer level, considerable thought has been given to the possibility of spending days in the field with patients beyond the famed golden hour. Due to this, prolonged field care has become the next level it TCCC advancement. Several commercial companies, such as North American Rescue and Apollo Training Group, have implemented PFC training courses and individual skills courses. The Army has been experimenting with several courses that include curriculum involving specific PFC training. The Navy as of yet has not implemented or tested any course that includes medicine beyond the 24 to 72-hour mark that TCCC is supposed to encompass. 

The elite Navy SEALs medics and MARSOC SOIDC’s and Force Recon SARCs are all members of the Navy, yet for advanced medical training, they receive training at the Army’s Special Operations Medic Course (SOCM). Naval Special Operations Medical Institute (NSOMI), the SOCOM version of NEMTI, is actually a detachment based out of Fort Bragg. 

View of TCCC in the Hospital Corps

As of 2018, all new Hospital Corpsman coming from A-School, regardless of rank, are going to shore commands at a naval clinic, or medical treatment facility. The initial goal of this was to reinforce training and new skills learned at A-School, before going to an operational command. 

Unfortunately, many new Corpsmen are finding their skills are atrophying with lack of sustainment training and the inability to train in tactical medicine and patient care. Many are being stuck in departments such as administration, medical records, or specific clinics such as cardiology where cardiovascular technicians due to the vast majority of work. 

With the War on Terror going on for almost 18 years, some new Corpsmen are finding that they are now receiving a ribbon for a war that they know little about, and soon we will have Corpsman who were not even born when it began. 

The lack of combat deployments, as well as many of the shore side commands, has brought a sense of complacency around the subject of TCCC and tactical medicine as a whole. For the Corpsmen who have deployed, and did treat casualties, the wounds are all too fresh. Yet many of those are leaving the military, or in leadership roles where the conversation of how you treated your best friend doesn’t come up. 

On the Marine’s side of the house, TCCC is practiced constantly, and a deployed Corpsman is expected how to know how to perform medical skills, just as he is expected to know how to use his M4. Unfortunately, to many, advancing their medical knowledge is left to them. Commands lack funding and manpower to send them to longer courses about specific topics, such as prolonged field care or ultrasound in austere environments. 

The basics of TCCC are performed well by the vast majority of seasoned Greenside Corpsmen, but an almost universal deficiency of medical knowledge about prolonged austere medical care, coupled with the lack of Navy schools and a commands ability to send an individual Corpsman to training compounds the problem. Hopefully, it will not take another war to push the Navy, as well as the military as a whole, towards a new side of tactical medicine. 

This article was written by Andrew O’Brien, an active-duty Navy Corpsman and former SWAT and intercept paramedic. Any views expressed in this article are solely that of the author, and may not express the official views of the United States Government, Department of Defense, or the United States Navy and United States Marine Corps.