EMS Tactical Combat Casualty Care

Tactical combat casualty care (TCCC or TC3) is the accepted battlefield prehospital standard of care. TCCC was reviewed and approved by the Committee on Tactical Combat Casualty Care (CoTCCC), established by the US Special Operations Command in 2002. Now, the CoTCCC operates under the Department of Defense (DoD) Joint Trauma System (JTS). The committee is formed by physicians, providers, and medical technicians across branches of the United States Army, Navy, Air Force, Marines, and Coast Guard and has 42 voting members. TCCC originated as a Naval Special Warfare biomedical research project in the early 1990s and was first published as a  supplement in 1996. This research was stimulated by evidence showing that tactical medicine environment and care differed substantially from typical prehospital medicine and that 90% of all combat deaths occur before reaching a treatment facility. That extremity hemorrhage was a major cause of combat death. This places the wounded combatant, unit medic, or fellow soldier in the primary role of life-sustaining care. Early and effective use of the tourniquet substantially improved outcomes through evaluation from 1993 to 1996; because of this, TCCC was formed and implemented, initially in small unit group tactics and eventually becoming the basis for trauma care in the battlefield setting. Currently, TCC is a DoD course offered by the National Association of Emergency Medical Technicians (NAEMT) in either a 2-day course for medical personnel or a 1-day course for all combatants. NAEMT also offers Tactical Emergency Casualty Care (TECC) for civilian emergency medical services (EMS).