AMC aims to increase casualty survivability in Afghanistan

  • Published
  • By Roger Drinnon
  • Air Mobility Command Public Affairs
Air Mobility Command is working jointly with other U.S. military services to improve emergency care for service members critically injured in combat by employing newly-developed Tactical Critical Care Evacuation Teams, or TCCETs.

These are three-member teams, each comprised of a highly-trained emergency medicine physician and two Certified Registered Nurse Anesthetists or Critical Care Nurses, now providing point-of-injury care and treatment during tactical evacuation of severely-injured troops in Afghanistan. Although only one such team is currently deployed to Afghanistan, more are expected to deploy in May.

"TCCETs provide initial emergency trauma care and resuscitation capabilities beyond those of field medics and flight medics," said Brig. Gen. Bart O. Iddins, AMC command surgeon. "Providing more advanced trauma care and aggressive resuscitation at the point-of-injury and throughout the evacuation process greatly increases the likelihood of patient survival from injuries deemed critical and immediately life-threatening, but potentially survivable."

AMC is the lead agency for military Aeromedical Evacuation worldwide. Within U.S. Central Command, AE missions are normally flown by air mobility aircrews and medical teams aboard C-17, KC-135, or C-130 aircraft, although essentially any AMC aircraft can be configured for these missions. AE crews have successfully completed more than 186,000 patient movements since the onset of Operations Iraqi Freedom and Enduring Freedom.

However, successful evacuation of the injured remains a joint service effort. Emergency tactical movement of patients from point-of-injury or remote combat outposts often involves rotary-wing aircraft, such as Black Hawk helicopters flown by U.S. Army personnel.

Over time, a combination of highly effective body armor, first-responder Tactical Combat Casualty Care/Self-Aid and Buddy Care, rapid casualty evacuation from the battlefield, a highly-integrated trauma system of forward surgical teams and theater hospitals, timely AE and Critical Care Air Transport have resulted in the highest casualty survival rate in the history of modern warfare. In fact, U.S. casualties have a 95 percent chance of survival once they enter the theater medical system, according to Joint Theater Trauma Registry data.

The need for tactical critical care evacuation is driven by casualty data that indicates many deaths are occurring from severe yet potentially "survivable" injuries in the pre-hospital environment. Feedback from the field also indicates severely-traumatized, post-surgical and resuscitative-care patients frequently require treatment exceeding the capability of flight medics who typically provide medical care during intra-theater patient movement. In August 2011, the Defense Health Board tasked all services to develop and implement solutions to close the critical care gap during all phases of en route casualty care starting from the point of injury. Specialized, highly-trained Tactical Critical Care Evacuation Teams are a solution.

In addition to their standard medical training and specialized qualifications, TCCET members complete additional emergency medical training courses, including: Advanced Cardiac Life Support; Advanced Trauma Life Support; Pediatric Advanced Life Support; and Critical Care Air Transport Team qualification via the Center for Sustainment of Trauma and Readiness Skills. Members also complete the Joint En Route Care Course and Joint Forces Combat Trauma Management Course, as well as five weeks of intense Combat Skills Training necessary to ensure the safety of patients and fellow team members in hostile environments.

Iddins said feedback from redeploying teams and other services will be the key to developing collaborative, joint solutions to tactical critical care patient evacuation. He said AMC will refine the TCCET concept as lives are saved and teams return with recommendations on how best to train members and integrate TCCETs into the en route care system.

"We will continue to gather data to determine the most effective team composition and methods," said Iddins. "Lessons learned from redeploying TCCETs are being used to improve training and equipment development as well as to finalize the overall concept of operations and related tactics, techniques and procedures."