A lot gets written about TCCC and its application for law enforcement in police news, but few articles actually translate this wealth of information into actual, hands-on knowledge for the individual officer. If we spent as much time really understanding what TCCC teaches us as we do looking at new kits or debating needle decompression, we might find ourselves in a much better position to help our brothers and sisters when they need it.
Tactical Combat Casualty Care (TCCC) is the military’s approach to how to treat victims of traumatic injuries sustained on the battlefield. The original TCCC guidelines were written in 1996 and a standing committee on TCCC (the CoTCCC) was formed in 2001 to ensure that they were regularly updated and complied consistently with best practices in battlefield care of police news. The primary difference between TCCC and civilian trauma medicine is that on the battlefield, the patient is part of the mission, whereas in civilian models, the patient is the mission. TCCC strives, therefore, to combine sound medicine with sound small unit tactics. Obviously, this approach to dealing with traumatic victims in the face of danger is well suited for the law enforcement world as well.
At its core, TCCC breaks down the treatment of injuries into three priorities:
1. Treat the casualty;
2. Prevent additional casualties;
3. Complete the mission.
Perhaps the greatest difference between civilian care and TCCC are the fact that these three priorities are not always placed in this order. There may be times when treating the casualty has to take a second seat to either preventing additional casualties or completing the mission. In police news, this is a huge contrast from the training many of us have experienced and this paradigm shift will take some time to absorb completely into the mindset of most officers. That said it comes from a position of sound reasoning when faced with an immediate threat. For instance, if your partner is shot by an armed perpetrator and now lies exposed to fire, who will you be rescuing if you expose yourself to that same fire in an attempt to render care? In this case, the best hope for your police partner may be to eliminate or suppress the threat first to prevent further casualties (you) and then render effective medical care. This may take some strong will power to overcome your desire to help your fellow man but in many situations, the best medicine is superior firepower and sound tactics.
Of the three phases of care outlined in TCCC (care under fire, tactical field care, and tactical evacuation care) police news, care under fire is undoubtedly the most relevant for most officers. This phase of TCCC is all about removing the victim from the threat and stopping the most immediate threats to life, which are the bad guys and bleeding. Here’s a short version of the principles of the care under fire phase, we’ll look at these more in depth later on.
(Comments in italics are the authors)
1. Return fire and take cover.
Eliminate or suppress the threat. Protect yourself and your fellow officers first.
2. Direct or expect casualty to remain engaged as a combatant if appropriate.
Injured does not mean dead! Stay in the fight until the end. A combatant who isn’t firing back makes an easy target.
3. Direct casualty to move to cover and apply self-aid if able.
Again, injured does not mean dead or helpless. Help the injured officer determine which direction to move. A call of “Come to me!” can go a long ways towards reorienting the injured person and giving them a goal. Once they’re in a position of safety, remind them to treat themselves if they can. Many soldiers injured in the GWOT are alive today because they were provided the training and tools to treat their own injuries.
4. Try to keep the casualty from sustaining additional wounds.
This means getting the officer to safety if possible, and effectively returning fire to either eliminate or suppress the threat.
5. Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process.
6. Airway management is generally best deferred until the Tactical Field Care phase.
This is completely contrary to what most of us have been taught, but in reality if the victim cannot maintain their own airway; doing so will likely take you out of the fight. Further, according to the CoTCCC, combat deaths due to airway compromise are relatively infrequent and if the victim has an airway issue, they’re unlikely to survive regardless of what steps you take.
7. Stop life-threatening external hemorrhage if tactically feasible:
- Direct casualty to control hemorrhage by self-aid if able.
- Use a tourniquet for hemorrhage that is anatomically amenable to tourniquet application.
- Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.
You’ll note that this is the only medical procedure listed in the care under fire phase of TCCC for police news. This is because bleeding kills quickly, is easily treated, and takes very little time to effectively control. If you can get the victim to treat himself, do it. If not, and it’s tactically sound, render care by applying a tourniquet. Do not attempt to use direct pressure before applying a tourniquet. Stop the bleeding as quickly as possible and get back in the fight!
TCCC is not magic. It is a thought process that attempts to frame the priorities of treatment of wounded soldiers or officers in light of realistic tactical settings. Police officers should become familiar with these principles, plan them, and practice them so that when the time comes, they’re prepared to put them in motion.