Intro To Tactical Combat Casualty Care (TC3)

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    • #92385
      Max
      Keymaster

        Introduction to Tactical Combat Casualty Care (TC3)

        Some of this is straight from US Army 68W Combat Medical protocols, some of it is at the CLS (Combat Lifesaver) level, and there is a bit of opinion thrown in there too…..it is partly excerpted from the chapter in ‘Contact!: A Tactical manual for Post Collapse Survival‘ on casualties.

        Contact! A Tactical Manual for Post Collapse Survival

        This post would be usefully read along with ‘SHTF Combat Casualty – Considerations & Realities‘. Remember that these TC3 protocols assume evacuation to definitive care (Combat Hospital), so in the absence of that you have other factors to consider. The linked post delves into that  a little

        Unlike the normal ABC medical protocol that you will have heard about, the combat protocol for trauma situations is M-A-R-C-H, which puts Massive Hemorrhage before Airway, if it is indicated, but still includes Circulation for less serious bleeds and IVs. The other big difference is tourniquets: tourniquets used to be considered a tool of last resort. Now they are considered a tool of first resort in a combat environment. The following article is a basic summary.

        M -Massive Hemorrhage

        A – Airway

        R – Respiration

        C – Circulation

        H – Hypothermia

        (This used to be H-A-B-C. Hemorrhage-Airway-Breathing-Circulation. Pretty much the same thing).

        Some procedures that are appropriate in a civilian ambulance situation are not appropriate on the battlefield. Ambulance crews may give fluids to casualties on the way to the hospital, where blood transfusion  is available. They can, in simple terms, keep putting the fluids in and get definitive care once they arrive at the emergency room. In a battlefield situation, fluids are not given except in specific circumstances. In simple terms, when you go into true shock by losing circulating body fluids (i.e. blood) your blood pressure will drop. As your body responds to the injury and the loss of blood, it will draw blood into the vital organs at the core of the body, at the expense of the limbs. Thus, as blood pressure falls you begin to lose the distal pulses (i.e. in the wrist and foot), then closer and closer to the core until you have no pulses but the heart, and the heart will be the last to give out at the lowest blood pressure. In a combat situation, if you give too much fluid, there is a danger of “blowing the clot” and effectively bleeding out while diluting the blood left in the body, reducing its ability to carry oxygen. Also, fluids frequently given such as Lactated Ringers are rapidly absorbed into tissue, so over time they are not really effectively increasing the volume of the blood.

        The fluid given for a traumatic wounding on the battlefield is not lactated ringers or similar, but Hextend, which is a starch product. Over roughly an hour, 500ml of Hextend will draw fluids out of surrounding tissue and bulk up to around 800ml. Guidelines state that you can use a maximum of two 500ml bags, 30 minutes apart. The protocol is only to give fluids if there are no radial (or pedal) pulses, which are the distal pulses in the wrist or foot. The reason is that you want to bring the blood pressure up enough to restore distal circulation to the extremities but no more, because you don’t want to ‘blow any clots’ or cause the casualty to ‘bleed out’. For other injuries such as dehydration other fluids are still given, but not for trauma. IV fluids has now been taken out of the combat lifesaver curriculum, to prevent the problems alluded to above. Combat medics will at minimum put a saline lock into the casualty, to allow IV access if needed, and may give Hextend if indicated by the absence of distal pulses.

        The fact is that a large number of combat injuries are not survivable. Sometimes this will be obvious and the casualty has no chance of survival. Other times, survival will depend on appropriate interventions followed by rapid evacuation and definitive surgical care. There is a difference between being able to keep someone alive at the point of wounding and continuing to keep them alive due to the presence or absence of available definitive care. Do what you can to initially prevent death and get them to someone who can help, or worst case read some books on battlefield surgery and do something yourself, even if it’s just cleaning, debriding and suturing wounds and providing antibiotics, hoping that internal injuries and bleeding are not too severe and will heal in time.

        The use of body armor will reduce the incidence of penetrating trauma sustained in combat to the torso and the damage and resulting internal bleeding. Historically, 90% of combat deaths occur before the casualty reaches the treatment facility. The three major, but potentially survivable causes of death on the battlefield are: extremity hemorrhage exsanguination (severe bleeding), tension pneumothorax (oxygen shortage and low blood pressure due to a collapsed lung, a condition that may progress to cardiac arrest if untreated) and airway obstruction. Historically, the most frequent and preventable of these causes of death is extremity bleeding. Most wounds to the extremities will cause death by bleeding out, and this is preventable. Some combat wounds are simply not survivable and will not respond to medical attention i.e. severe internal bleeding or visible brain matter etc.

        Cardiopulmonary resuscitation (CPR) Resuscitation on the battlefield for victims of blast or penetrating trauma who have no pulse, no breathing, and no other signs of life will not be successful and should not be attempted. However, casualties with torso trauma or polytrauma who have no pulse or respirations during TFC should have bilateral needle decompression performed to ensure they do not have a tension pneumothorax prior to discontinuation of care.

        Care Under Fire:

        In this phase the casualty is “on the X” at the point of wounding. This is the point of greatest danger for the CLS. An assessment should be made for signs of life (i.e. is the casualty obviously dead). Cover fire should be given and fire superiority achieved. The casualty should be told, if conscious, to either return fire, apply self-aid, crawl to cover or lay still (don’t tell them to “play dead!”). Once it becomes possible to reach the casualty, the only treatment given in the care under fire phase, if required, is a hasty tourniquet “high and tight” on a limb, over the clothing, in order to prevent extremity bleeding. The casualty should be rapidly moved to cover (drag them).

        Tourniquet application: “high and tight” means right up at the top of the leg or arm, right in the groin (inguinal) or armpit (axial) region. The tourniquet needs to be cinched down tight to stop the bleeding. Use/purchase the CAT – Combat Application Tourniquet.

        When applying tourniquets, they need to be tight enough to stop the distal pulse i.e. the pulse in the foot or wrist, assuming the limb has not been traumatically amputated. You will not be able to check this pulse at this phase, so just get the tourniquet on tight and check the distal pulse as part of the next phase, tactical field care.

        Traumatic amputation: get the tourniquet on high and tight and tighten it until the bleeding stops. Note: in some circumstances there will be pulsating arterial bleeding and severe venous bleeding, but other times it is possible that there may be less bleeding initially as the body reacts in shock and “shuts down” the extremities, but bleeding will resume when the body relaxes. So get that tourniquet on tight.

        Compartment Syndrome: you don’t want to be feeling sorry for the casualty and trying to cinch the tourniquet down ‘only just enough’. Tighten it to stop the distal pulse. If you don’t, the continuing small amount of blood circulation into the limb can cause compartment syndrome, which is a build-up of toxins: when the tourniquet is removed, these toxins flood into the body and can seriously harm the casualty. In an SHTF situation when there may be no definitive care, you may want to loosen the tourniquet for five minutes every 30 minutes after the initial two-hour period. This will help prevent muscle and nerve damage. Pure TC3 protocol does not allow this, and tourniquets can be left on for up to six hours as they are evacuated to definitive care.

        For an improvised tourniquet, make sure the strap is no less than 2 inches wide, to prevent it cutting into the flesh of the limb.

        Tactical Field Care:

        Once the casualty is no longer “on the X”, CLS can move into the Tactical Field Care phase. This is where the CLS conducts the assessment of the casualty and treats the wounds as best as possible according to M-A-R-C-H:

        Massive Hemorrhage: During the Tactical Field care phase, any serious extremity bleeding (arterial or serious venous) on a limb, including traumatic amputation, is treated with a tourniquet 2-3 inches above the wound. Axial (armpit), inguinal (groin) and neck wounds are treated by packing with Kerlix or combat gauze (treated with hemostatic agent, commercially available from Quickclot) and wrapping up with ACE type bandage.

        Once you have dragged the casualty to cover, you will conduct a blood sweep of the neck, axial region, arms, inguinal region and legs. This can be done as a pat down, a “feel” or “claw”, or simply ripping your hands down the limbs. Debate exists as to the best method. Conduct the blood sweep and look at your hands at each stage to see if you have found blood. Once a wound is found, check for exit wounds. Ignore minor bleeds at this stage: you are concerned about pulsating arterial bleeds and any kind of serious bleed where you can see the blood rapidly running out of the body.

        Beware of deliberate tourniquet application to the lower limbs, below the knee and elbows. The two small bones there may cause problems, particularly with traumatic amputation, and the tourniquet may either not be effective or cause further harm to the casualty. Assess it. Also, if the injury is, for example, below the knee, then don’t put the tourniquet over a joint (i.e. knee), put it above the joint.

        Consciousness: As you ere dealing with the casualty, you are assessing the level of consciousness and whether they have an altered mental state (consider removal of weapons for those with an altered mental state). You also reassuring the casualty and explaining what you are doing. If the casualty is talking or screaming, you know they have an airway.

        Assess level of consciousness: AVPU  – which level are they responsive at:

        Alert – Voice – Pain – Unresponsive

        Airway: CLS can aid the airway by positioning (i.e. head tilt/chin lift to open the airway, recovery position etc.) and use of the NPA (naso-pharyngeal airway – nose tube!). An NPA should be used for any casualty who is unconscious or who otherwise has an altered mental status.

        · Consider use of an NPA, mouth sweep and suction. You need to be trained on these items.

        · Combat medics are trained to carry out a crycothyrotomy (“crike”) to place a breathing tube though the front of the airway (an NPA can be used as the tube if you lack the correct equipment). This is an effective way of quickly opening the airway on the battlefield, particularly for facial trauma of burns to the face and airway.. If you are trained and have the equipment you can use patent airways that insert into the mouth and are of the types that paramedics are be trained to use: Combi-tubes and King Airways.

        · A crike will save life but assumes that you are heading to a hospital for treatment and repair. The tube will go through the membrane and this will need to be repaired. However, if it is your option to save life, do it and figure out the details later.

        Respiration: Occlusive (airtight) adhesive dressings are used to close any open chest wounds. Check for exit wounds! Check the integrity of the chest: ribs and breast bone. You will have to open body armor to do this. If signs of a pneumo/hemo-thorax develop (progressive respiratory distress, late stages would be a deviated trachea (windpipe) in the neck as a result of the whole lung and heart being pushed to one side by the pressure of the air build up in the chest cavity) then needle chest decompression can be performed (NCD).

        · If you don’t have a specific occlusive dressing, use something like plastic (or the pressure dressing packet) and tape it down over the chest wound. The old school method was to tape three sides to let air escape, current thinking is to tape all four sides down to seal the wound.

        · NCD involves placing a 14 gauge needle, at least 3.25 inches long, into the second intercostal rib space (above the third rib) in the mid-clavicular line (nipple line). This is basically a little below the collar bone, in line above the nipple. The needle is withdrawn and the cannula is left open to air (tape it in place). An immediate rush of air out of the chest indicates the presence of a tension pneumothorax. The maneuver effectively converts a tension pneumothorax into a simple pneumothorax.
        (The definitive treatment is to get a chest tube in, in the side of the chest (eighth intercostal space); to drain the blood and air that is filling the chest cavity.)

        Circulation: You then move on to Circulation , which consists of two parts:

        1) Bleeds:  At this point you can choose to convert any hasty tourniquets applied during care under fire to deliberate tourniquets. This involves placing a deliberate tourniquet at the appropriate point on the limb, loosening the hasty tourniquet, and assessing whether the new deliberate tourniquet is going to prevent blood loss. If a deliberate tourniquet is not going to work, re-tighten the hasty tourniquet.

        You can also attempt to downgrade/convert any hasty tourniquets, perhaps over-zealously applied during the care under fire phase as a precaution, to a pressure dressing. At this point you would pack the wound with combat gauze, kerlix, or equivalent and then apply the emergency bandage (Israeli pressure dressing) over the top. Remember, this is a pressure dressing and not a tourniquet. Once this dressing is in place, you can slowly loosen the tourniquet, and assess if the pressure dressing is holding. If not, reapply a deliberate tourniquet.

        The rest of the activity under circulation is dressing minor wounds with gauze/Kerlix/ACE wrap, and covering and taping any other interventions. For example, deliberate tourniquets that are to be left in place should be completely taped and then the time written on the tape.

        2) Fluids: This is no longer a combat lifesaver responsibility. For a combat medic, if distal pulses are present, a saline lock will be applied. If no distal pulses, Hextend will be administered. One 500 ml bag, then check again after 30 minutes. It still no distal pulses, administer one other bag.

        Once you have completed both parts of circulation, you will consider the administration of any pain medications you have.

        Hypothermia: The loss of circulatory body fluids, and in particular with burns (the skin regulates body temperature) puts the casualty at serious risk of hypothermia. This is mainly why, somewhat counter-intuitively, dry rather than wet dressings are indicated for burns. The wet dressing may kill the casualty from hypothermia. Whatever the weather, however hot it is, you should carry emergency blankets. Once you have conducted M-A-R-C-H you then package the casualty in a thermal blanket and strap them down to a stretcher as appropriate.

        Recovery position/position of comfort: The recovery position, with the unconscious casualty laying on their side, is a good way to ensure continued open airway and drainage. It may not be appropriate if the casualty has to be strapped to a stretcher for evacuation. If this is the case, the casualty must be monitored as they are moved to ensure the airway stays open – it is the base of the tongue falling back over the airway that causes most airway blockages in an unconscious casualty on their back. That and vomit/blood. For conscious casualties it is often best to allow them to adopt the most appropriate position of comfort, within the requirement of having to evacuate them.

        Note: An NPA aids with an airway but does not keep it open. An OPA (oral airway) will maintain an airway but can only be tolerated by an unconscious casualty.

        Full Assessment: Once you have completed M-A-R-C-H you will then do the full assessment. This is a thorough head to foot assessment of the casualty and also allows you to check previous interventions as you move through it in a methodical manner. It is a physical check of the casualty from head to foot. As you do this you can continue to reassure the casualty, check the level of consciousness, and continue to monitor vital signs such as breathing.

        As you go through the assessment you are looking for the following indicators as you put hands on and observe the complete body from head to foot:

        Breathing: rate, rhythm, quality. Adult: 12-20 breaths per minute is normal.

        Circulation: Skin: CCT: color, condition, temperature. Capillary refill.

        DCAP-BLS: deformities, contusions, abrasions, punctures/penetrations/paradoxical motion, burns, lacerations, swelling.

        TIC: tenderness, instability, crepitus.

        BUDS: bleeding, urination, defecation, secretions.

        PMS: pulse, motor, sensory.

        PERRL: pupils equal round, regular size, reactive to light.

        Once the assessment is complete, you will repackage the casualty and as time moves forward you will continue to reassess the state of the casualty. Units will use casualty cards so that the injuries can be described once they are evacuated back to the next level of care. A more practical and useful method is to unroll and stick a length of tape from the casualties IFAK onto their chest, and write the relevant stuff down with a sharpie. It won’t then go missing. You can even just write it on them if you need to.

        You will continue to monitor the casualty and perform interventions as necessary both prior to and during the evacuation.

        Live hard.

        Die Free

        Max

      • #92386
        HiDesertRat
        Participant

          Max,

          Recently read in The Journal of Trauma and Acute Care Surgery a research paper entitled “The Profile of Wounding in Civilian Mass Shooting Fatalities”. Interestingly, the conclusion was that TC3 training, for military environment, while appropriate, may not fit the patterns of civilian trauma and may require some modification. Their specific finding that exsanguination from an extremity wound was particularly rare event in the civilian arena (less use of TQ required), and that the survivable wounds that were more treatable were chest injury with potential tension pneumohemothorax and to a lesser extent, airway obstruction.
          Also of interest was the higher incidence of GSW to the upper torso “center of mass” due to the closer distances involved and lack of body armor vs battlefield environment, and of course lack of blast injuries as seen by the military. Lots of info to parse from the article. I would be remiss in not adding that I was led to this paper because it was referenced in survivalblog.com.
          Any thoughts or comments appreciated.

        • #92387
          Max
          Keymaster

            Quick thoughts, in no particulate order, because I have not had time to read the article you reference:

            1) Use of ballistic plates is a significant factor in reducing the incidence of penetrating trauma to the torso. There is your first clue as to the use of ballistic plates! This is a factor on the modern battlefield.

            2) TC3 is not aimed at surgeons, but at grunts, and as such offers a series of protocols the grunt can do, at the point of wounding, to give people the best chance of survival as the move back through the chain. Statistics say that on the battlefield, you need to treat the main preventable causes of death fast, or they will die at the point of wounding and not make it back to surgery.

            3) TC3 focuses on the treating the primary PREVENTABLE causes of death, and uses the MARCH protocol to do that. Thus extremity exsanguination is treated before pneumo because you will die first of it. It does nto mean that the tension pneumo does not have to be treated. (this does apply with the use of ballistic plates, even though the statistic go back to Vietanm – plates doe not prevent all torso/thorax wounds, due to limited coverage).

            4) Death from extremity bleeding is probably less of an issue in a civilian environment due to the speed of response of ambulance. Just guessing from how they may compiles their statistics. However, you can be dead from it in 30 seconds, and if you are bleeding out in a gay nightclub in Orlando, and the SWAT hold back for 3 hours, you need a TQ. Context and situation.

            caveat: I am not a Doctor, I’m just a grunt trained in TC3.

          • #92388
            HiDesertRat
            Participant

              Max, agree with all you say. Since I have never seen any comparison of TC3 utilization in the civilian space actually researched thought it might contain some useful information, so I mentioned it. Does not change the need for training TC3 which is useful in any scenario where mayhem results in injuries, no matter the cause.

            • #92389
              gramma
              Participant

                Just a question: any chance this kind of training will be added into the calendar for WV?

                Figure I’ll start there (being no spring chicken) while I refresh my handgun/rifle basics… then come find out how to make those wounds.

              • #92391
                rthorrsen
                Participant

                  related to this topic, i joined the forums to get a straight answer from someone with experience.

                  scenario: 2 sticks of 2 troopies (4x total) each are firing and manoeuvering. one troopie gets an extremity bleeder and must self-apply their TQ. in my position, i must ensure the 3 remaining guns are in the fight and making the scene safe. if i were to follow standard TTPs, i’d have my team push through the OPFOR position to the LOA and set security. all this time, the bleeder is sitting where hit and with luck got the TQ applied properly.

                  question: at which point can i as TL either go myself or assign a troopie to see to the wounded stick member? must i make sure every troopie is completing the actions on the OBJ before i see to wounded?

                  this scenario is vexing me as i transpose it to a WROL situation without more ground support. thank you in advance.

                • #92392
                  wheelsee
                  Participant

                    @rthorrsen

                    Go to the Case Studies AFTER reviewing the information…..

                    http://naemt.org/education/naemt-tccc/tccc-mp-guidelines-and-curriculum

                  • #92393
                    rthorrsen
                    Participant

                      @wheelsee

                      thank you for the link, but can you offer some more guidance on where those Case Studies are? i can see now my hope for a straight answer was dead on arrival, but that’s no one’s fault but mine.

                    • #92394
                      wheelsee
                      Participant

                        @wheelsee

                        thank you for the link, but can you offer some more guidance on where those Case Studies are? i can see now my hope for a straight answer was dead on arrival, but that’s no one’s fault but mine.

                        Because there’s no straight answer without knowing details…..

                        I.E. who amongst the squad are 1st Aid trained?? who is the team medic?? Are there multiple medics?? what resources are being carried by each member?? what total resources are available?? what was the mission?? who is the casualty?? what is the severity?? (yes, you mentioned self-aid, but is it controlled now or was it half-ass and has now bled out). Have you won the fight?? Is there still incoming fire?? Is bad-guy reinforcements on the way?? If so, how close?? Did you make prior arrangements for CasEvac (casualty evac)?? If so, how far away is your RV point? If not, how are you going to evac??

                        Without knowing details to simple questions, there is/are NO straight answer(s).

                      • #92395
                        wheelsee
                        Participant

                          @wheelsee

                          thank you for the link, but can you offer some more guidance on where those Case Studies are? i can see now my hope for a straight answer was dead on arrival, but that’s no one’s fault but mine.

                          Follow the link….. scroll down to the PowerPoint presentations, click, scroll down to the “Critical Decision Case Studies”

                        • #92396
                          Max
                          Keymaster

                            @wheelsee

                            thank you for the link, but can you offer some more guidance on where those Case Studies are? i can see now my hope for a straight answer was dead on arrival, but that’s no one’s fault but mine.

                            Holy balls! So you say you joined the forum for this one answer and now already your hopes are dead? WTF? I am seeing this pop into my email simply because I am subscribed to the thread. It’s 21:30 on Friday night.

                            You will get an answer when I have time. But I’ll tell you now it won’t be short. Wheelsee is hitting the nail on the head. I’m not sure where you are getting your tactics and assumptions from but you appear to be playing checkers. That’s the issue. And your scenario needs to be dissected based on “it depends” before any sort of straight answer can be given.

                            Out.

                          • #92397
                            rthorrsen
                            Participant

                              thank you, @Max and @wheelsee. In the last 24 hours I’ve got a link to a great TCCC site and a short lesson on patience from a renown author. This is the most help I’ve got from people who don’t know me in a long time.

                              The scenario given is the most watered down i can manage without writing a short story, and given the details, there are a million ways to skin that cat, so it’d become a pick-your-own adventure. the problem on my end is there is no clear doctrine, so it is up to me to make the call. hence, i solicit from you who i think have some goodness to offer.

                              @wheelsee, please let me fill in some of those answers, and seriously, friends, i didn’t mean to have this be your Friday night…

                              who amongst the squad are 1st Aid trained??
                              – i am, and i teach MARCH to the rest
                              who is the team medic??
                              – i am, but also the squad leader in this scenario
                              Are there multiple medics??
                              – for this purpose, yes
                              what resources are being carried by each member??
                              – basic IFAK (TQ, NPA, compression bandage, needleD, chest seals, dressing)
                              what total resources are available??
                              – in an austere environment, only what’s at hand; no support immediately, but telemed is a call away and a medevac can be called after several hours
                              what was the mission??
                              – defend a fixed location against lightly-armed assault for a 12-hr period IOT train a team for safe house OPs and use of TCCC in an austere environment
                              who is the casualty??
                              – civilian trainee with some SUT experience
                              what is the severity?? (yes, you mentioned self-aid, but is it controlled now or was it half-ass and has now bled out)
                              – well that’s the crux of the argument; i am dealing with a possible bleedout from a severed artery. if i did my job and the troopie applied the TQ correctly, then the question is a lot less grave
                              Have you won the fight?? Is there still incoming fire??
                              – in this snapshot, the incoming fire is stopped, but i have no eyes on the shooter’s location (50 m away) beyond the erstwhile cover, or any intel whether reinforcements are on the way – and this goes back to my question – with only 3 of my team left including me, i would set the other stick in place to conduct SLLS while i go and aid my down troopie. i’d like to solicit opinions on that.
                              Is bad-guy reinforcements on the way??
                              – UNK but assumed yes
                              If so, how close??
                              – UNK
                              Did you make prior arrangements for CasEvac (casualty evac)??
                              – in this sceanrio, roads are blocked so no vic use, but i add in a notional helo at the end so the trainees can experience reading a 9-line or improvising a 4-line
                              If so, how far away is your RV point?
                              – only 100m or so from the triage collection area; long enough to demo litters, but not too much to tire people out
                              If not, how are you going to evac??
                              – in a real-world situation, this question keeps me up at night

                            • #92398
                              wheelsee
                              Participant

                                @rthorrsen

                                Strictly my opinion, but you’ve already set your team/mission up for failure.

                                1. from my experience (SWAT medic, 1990-1995) – the medic should NOT be the TL. As medics, we were new to the SWAT concept (and vice versa). Our TL wasn’t sure where to put us so we were tail-end Charlie. Conceptually from the TL’s perspective, it made the best sense, as it kept the medics in a “safe position.” The problem arose when we took down a location in gang-territory and a medic was needed. Billy and I looked at each other like, “who’s going??” We were providing rear-security in an area that needed it. It all worked out because there were 2 of us but it highlighted a problem. From then on, the medic stayed within 1-2 people of the TL.

                                2. Role delineation – as a firefighter, the captain is at the pivot point. Anything above (District chief, Battalion chief, x Chief, etc) MUST maintain situational awareness. Meaning – the Chief NEVER fights fire. The moment he does, his team is in peril as no one has overall situational awareness, no one “reading” the fire ground. The moment the TL gets sucked into providing patient care, the team is in peril.

                                3. EVERYONE must be capable of self-aid. IOW, my buddy goes down, my job (and I AM a medic) is to return fire and win the fight. It is ONLY when the fight is over that we can quickly reload, reassess, and start CasEvac. See some of the scenarios I previously linked to. Even the medic continued fighting until the “scene was safe.”

                                4. Role delineation – why are YOU providing care?? (I’ve already discussed this but it bears repeating).

                                5. You say austere environment but then mention tele-med and helos…..these are, IMHO, mutually exclusive. Austere medicine (as defined by John Hopkins Medicine is “low-resource environment”) doesn’t include either of your assumptions.

                                6. My job, as the Medic, was to inform the TL of potential health/medical issues, but the final say ALWAYS belonged to the TL. I adapted my practice as need to meet the overall needs of the team.

                                These are things just off the top of my head. I do not know your background, skill set, education, knowledge, etc. But I do urge you to rethink your scenarios….

                                If you haven’t trained at MVT (from your post, I’m inclined to think not – you mention defending a fixed position – ask ANYONE who has been through Max’s CQB/FonF – fixed means dying), I challenge you to do so. YDKWYDK – come train and widen your horizons….. best wishes

                              • #92399
                                rthorrsen
                                Participant

                                  @wheelsee, I can’t thank you enough for this feedback on my thought experiment. I came here to learn, and that’s what I got. the biggest takeaway for me is that I concentrated on one thing, thinking there was a clear answer, got frustrated, and missed a very big picture. Checkers, indeed. If this is the caliber of attention you give a straight newb to TCCC, then I will make an honest effort to experience what MVT has to offer.

                                  Thank you for being so patient.

                                • #92400
                                  Joe (G.W.N.S.)
                                  Moderator

                                    rthorrsen welcome to the Forum.

                                    We have an extremely diverse group here with backgrounds ranging from military, doctors, and various tradesman.

                                    I encourage you to check out the various older Threads as there is a tremendous amount of information here.

                                    Feel free to ask questions or comment on anything you find, there is no such thing as a dead thread here.

                                    Again welcome.

                                  • #92401
                                    rthorrsen
                                    Participant

                                      Hello again everyone. Just to follow up, I found that short answer I was seeking on page 71 of the TM (yes, I still read paper books), and I’m diving into the TCCC case studies. While it is a short answer, I know there are cases where it isn’t final, but it pays to do your homework. I’ll cross those bridges when I come to them. Thank you, @maxvelocity, for putting it together.

                                    • #92402
                                      Billy
                                      Participant

                                        This is awesome, when is the TC3 class going to be held at MVT? Ill sign up as soon as its posted!!!

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