- Published: 21 June 2012
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The U.S. military is enjoying the highest casualty survival rate in the history of modern warfare, but medical officials believe they can save even more lives by getting advanced care sooner to injured troops. For nearly a year, a three-member team of Air Force health professionals has successfully evacuated and treated 299 severely wounded troops by taking the emergency department to the injured, and another team is set to stand up in the coming month. Known as tactical critical care evacuation teams, or TCCET, the teams comprise an emergency medicine or critical care physician, a certified nurse anesthetist and an emergency department nurse or intensive care/critical care nurse. The teams specialize in moving and treating patients who have just been injured and risk dying if emergency treatment isn’t administered immediately. The first team’s skills are being put to good use quickly as troops continue the fight in Afghanistan, where the improvised explosive device remains the enemy weapon of choice. Many of the casualties of Operation Enduring Freedom suffer blast-related injuries such as burns, lung trauma, traumatic amputation, blunt force trauma and head injuries, according to Air Mobility Command surgeon Brig. Gen. (Dr.) Bart Iddins. AMC is the lead agency for military aeromedical evacuation around the world, and missions are typically flown by air mobility aircrews and medical teams on C-17, KC-135, or C-130 aircraft. More than 186,000 patient movements have been successfully completed since the onset of operations Iraqi Freedom, New Dawn and Enduring Freedom. Though every combat medic and many nonmedical combatants are trained to deliver tactical combat casualty care on the battlefield, Iddins said the injuries sometimes are so severe that they exceed those capabilities. Tactical combat casualty care has saved many lives, but is in no way definitive treatment, Iddins said. “The casualty must still be evacuated to a higher level of medical care."
Bridging The Gap
Finding a way to provide more advanced care at the point of injury will provide a missing piece of the complex puzzle that is war-related trauma treatment. A study published last year in The Journal of Trauma found that 51.4 percent of “battle injury, died of wounds” deaths were “potentially survivable” injuries. Military medical officials believe tactical critical care evacuation teams can help turn that statistic around.
When it comes to treating and evacuating casualties with life-threatening injuries, the military has several options for treatment and evacuation, including its 119 critical care air transport teams, or CCATTs, of which 12 are deployed at any given time to support the war effort, according to Iddins.
Like the tactical teams, CCATTs comprise a three-member team of health professionals that include a critical care doctor, nurse and respiratory technician, but are mostly equipped for maintaining a stable patient during evacuation out of theater on a fixed wing aircraft, Iddins said.
The new tactical teams, which will fly most movement missions on rotary wing aircraft such as a Black Hawk helicopter, are equipped and trained to start trauma resuscitation treatment immediately after injury. And they’re able to do that work in the tight confines of a helicopter with very little equipment.
Iddins said the most common cause of preventable death on the battlefield is uncontrolled bleeding, loss of airway and tension pneumothorax in the lungs. Unlike those trained in first-responder care or combat care, TCCETs are trained and equipped specifically for dealing with such emergency scenarios, Iddins said.
The tactical team is capable of performing aggressive damage control resuscitation such as airway management, mechanical ventilation, blood administration/low-volume resuscitation, hemorrhage control, coagulopathy (bleeding) management, invasive monitoring, vasoactive (increase blood pressure) medication administration and other interventions as required throughout the course of an evacuation, according to Iddins.
That kind of aggressive treatment saves lives, Iddins said, but is beyond the scope of traditional pre-hospital tactical casualty evacuation capabilities. “TCCET is designed to bring a higher level of medical care directly to the casualty, specifically at the point of injury, in order to initiate emergency department/trauma department-level control resuscitation earlier and more aggressively than has traditionally occurred.”
Work Amid A Unique Environment
Maj. Michael McCarthy, deputy director at the Center for the Sustainment of Trauma and Readiness Skills in Cincinnati, said that though members of the new tactical teams can conduct a CCATT mission, the teams are specifically trained to deliver high-level, critical care in the tight spaces of a helicopter with limited supplies. Unlike CCATT members, tactical care team members also are trained in combat survival.
During their 10 weeks of training, McCarthy said, future team members will spend time in a simulator that mimics conditions in Afghanistan based on experience gleaned from the first team.
“You’re space-restricted, you’re in a dark environment where you have to use low light and capability,” McCarthy said. “We pipe sound in that’s about 90 decibels … and we make them do whatever the simulation or objective is.”
McCarthy said all the training is meant to help airmen adjust to the austere environment they’ll be working in and help them identify when they’re overwhelmed.
“The [task saturation] threshold is different for every person, but what we focus on here is that you be able to recognize that you’re getting task-saturated, take a step back, call a timeout and redirect your team,” he said.
McCarthy said this mission is unique to the military and the Air Force, though civilian air care programs have provided critical transport for years.
“They don’t bring the same capability that we do, they don’t do it in same austere environment,” McCarthy said. “They don’t have the same team component, and they definitely don’t function in a combat zone.”
Ready To Expand
The success of the first TCCET operating downrange has service officials champing at the bit to get the second team into action.
AMC plans to stand up the next team by the end of May or early June, Iddins said. The command also is expanding the number of personnel for sustaining current and future mission requirements.
Whether there will be more than two teams remains to be seen, but signs are good. Tactical teams are currently sourced from active-duty and Air National Guard components, but there are plans to put Air Force Reserve members in the mix as full teams or as individual augmentees, Iddins said. Team deployments are 179-day rotations.
“The TCCET casualty movements have been enormously successful — there have been no reported deaths, nor complications associated with TCCET movements thus far,” Iddins said.
By Markeshia Ricks - Staff writer