As a surgeon in training I worked extensively at a trauma hospital primarily taking care of blunt motor vehicle accident injuries and to a limited extent, penetrating trauma. All of my experience was in the hospital setting. As I became interested in firearms and concealed carry, I also became interested in the tactical side of things. A natural extension of my surgical background was to understand what happens in the field. What is the prehospital battlefield like and how are injuries managed there.
People who carry firearms for protection have a responsibility that goes beyond the safe deployment and use of a firearm in a tactical situation. I considered the aftermath of a shooting. What do you do if you or a bystander is shot after engaging a threat? I wasn’t sure I knew what I would do. Pack the wound, apply pressure, call 911 etc. This led me to the conclusion:
If you carry a firearm, you should know how to manage gunshot wounds in the field.
I started the research and found the military version of prehospital care in the form of Tactical Combat Casualty Care or TCCC. Designed in the mid 90’s for Special Operations medics to reduce preventable combat deaths while allowing for successful mission completion. The core mission of TCCC is to treat the casualty, prevent additional casualties and complete the mission.
TCCC is divides into 3 core components. Each of these is dynamic and overlap with the other. They are:
Care Under Fire -- get off the X (get out of the kill zone), take cover, return fire.
Tactical Field Care - MARCH program
Massive hemorrhage
Airway
Respiration and breathing
Circulation
Hypothermia
Tactical Evacuation Care (TACEVAC) – same elements as TFC with the addition of evacuation protocols.
I discovered there are similarities to Advanced Trauma and Life Support (ATLS). For example tactical field care is similar to the trauma ABCDEs:
Airway
Breathing
Circulation
Disability/Neurologic
Exposure
The difference is that you are in the field and a lethal force is trying to kill you. I never had an active shooter in Room 9 at University Hospital. I am sure it happens and we did have some gang retaliation and lockdowns but nothing like what our military experiences or like what a casualty experiences in the field.
One key success of TCCC is addressing life-threatening extremity hemorrhage with a tourniquet immediately in the field. Prior to tourniquet use in the field, fatalities were 7% for extremity hemorrhage versus 2.6% after. The second success is registers with the widespread training and equipping of military personnel. This allows for anyone in the unit to provide field care. Again, the importance of everyone knowing how to utilize the key elements of TCCC.
We are working on a more civilian based instruction program here at Wrightson Defense. Ultimately, the information is out there and training is available. Sometimes it is difficult to get the hands on experience that you need to apply a tourniquet or hemostatic dressings. I hope to get this set up this summer along with the basic med kits that everyone should have and will ultimately be part of our firearm sales.