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# Saving lives through Tactical Combat Casualty Care

By Master Sgt. Felix FigueroaNATO Special Operations Component Command-Afghanistan

KABUL, Afghanistan****- U.S. and NATO service members assigned to Hamid Karzai International Airport's Role 2 hospital recently sacrificed their spare time to train Force Protection service members in the art of Tactical Combat Casualty Care (TCCC). The phrase "Cheat the Reaper," which refers to saving lives, is found on an unofficial patch sewn onto the medical bags the 224th Area Support Medical Company, Maryland Army National Guard (ANG) medical team carries.

HKIA's Role 2 hospital is a NATO facility, based on a U.S. framework, providing routine and preventative medical care and emergency surgery. Hospital management and patient care is the primary mission. 

*"The fate of the injured often lies in the hands of the one who provides the first care to the casualty."*- *Unknown, Tactical Combat Casualty Care learning manuals*

Tactical Combat Casualty Care was designed in the mid-1990s for the Special Operations medical community and created custom guidelines for preventable causes of death on the battlefield, such as hemorrhaging and airway obstruction based on injury patterns from previous conflicts. Adopted by U.S. Special Operations Command in 2005, TCCC is now used widely throughout the U.S. military, the civilian sector and allied nations. 

According to the National Association of Emergency Medical Technicians (NAEMT), almost 90% of American service members who die from combat wounds die before arriving at a medical treatment facility. While the number is staggering, it illustrates the vital importance of first responders (medics, corpsmen, and other medical practitioners) on the battlefield today.

"Military medics are in high demand and limited. Therefore, TCCC training for non-medical personnel is not only important; it's critical," said Capt. Michelle Levesque, a U.S. Army TCCC training officer from the 224th assigned to the HKIA hospital.

Levesque, a hand surgery specialty physician's assistant in Baltimore, has dealt with a wide range of medical emergencies, from gunshot wounds to complete amputations and other upper extremity traumas. She said her civilian experiences, coupled with her military training, enable her to plan, oversee and implement realistic combat-based TCCC training.

"The goal of TCCC is to identify and treat those casualties with preventable causes of death and keep them alive long enough to reach a hospital," Levesque added.  

Levesque added that during her time at HKIA's Role 2 hospital, she and her team provided TCCC training every month to local service members, along with diverse groups such as Force Protection, Train Assist Advise Command-Air (TAAC-Air), and Security Force Assistance Brigade (SFAB). 

Those participating in the third iteration of TCCC training learned and were tested on: treating severe bleeding (hemorrhaging), tourniquet application, clearing and protecting the airway, treatment for penetrating chest wounds and on-scene safety.

After two days of classroom hands-on learning and step-by-step instructions, students donned body armor and tested their skills in a short field exercise, moving as a tactical unit through a training village within the base perimeter. Hospital staffers dressed as enemy role-players ambushed the TCCC students, requiring them to establish perimeter security measures, conduct follow-on casualty assessments and move to a Casualty Collection Point (CCP) where they were assessed on their newly acquired life-saving skills.

"Although this is my first deployment as medic, I am an EMT (Emergency Medical Technician) and firefighter back home in Annapolis," said Spc. Bradley Boucher, a 224th medic assigned to the hospital who served as an instructor for the TCCC training.

"I know all too well what it takes to get through a surreal and life-threatening situation," he continued.  While instructing the students, Boucher recalled one of his first calls as an EMT; responding to a domestic incident resulting in two gunshot victims. One of the gunshot victims died on the way to the hospital due to the severity of the wounds he sustained and the severe hemorrhaging accompanying it. The purpose of Boucher's story was to emphasize to the students the importance of controlling blood loss.

Another instructor, who has deployed multiple times to Afghanistan, used his experiences as a Romanian Special Forces nurse to illuminate lessons for TCCC students deployed for the first time.

"I've experienced my fair share of action against anti-Afghan government forces, witnessing many battlefield related wounds and injuries," said Ionut Amnar, a senior non-commissioned officer (OR-7) and Romanian Special Forces nurse at the HKIA Role 2 hospital.  "As a result, I stress to TCCC students the importance of stopping catastrophic bleeding, clearing and securing the airway, and respiration management." 

"From a medical provider standpoint, equipping other soldiers with pre-hospital lifesaving skills that can be readily used prior to medical personnel arriving on-scene provides a force multiplier aspect into any deployment setting," said Levesque. 

"The training provided to our NATO partners is designed to empower them, increase situational awareness and ensure survivability while out on missions," said HKIA Role 2 Hospital Commander Capt. Anne Alvarado, 224th ASMC, Maryland Army National Guard. "TCCC training provides all of that, along with peace of mind through confidence, knowing you can save a life." 

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