Two students drag a "shot" role player to a safer space.
Photo credit: Jim Bartlett
Students work through the treatment acronym MARCH as a coach watches on.
Photo credit: Jim Bartlett
Tactical Combat Casualty Care or “Tee Triple See” (TCCC) is a term coined by the military and now being adopted by law enforcement to designate immediate medical care given to trauma victims, but doing so under fire. This is a skill set that should be learned by everyone who regularly carries a firearm, but it’s training that’s not normally made available to non-military or non-law enforcement gun-toters. For that very reason, the Commonwealth Criminal Justice Academy in Fredericksburg, Virginia opened its doors and recently held an “open enrollment” TCCC course.
Understand as you read this that I’ve worn one uniform or the other (military or law enforcement) for more than 30 years. In that time I’ve had plenty of basic and advanced first-aid training, CPR, etc. I’ve also attended my fair share of SWAT schools, high risk entry schools, vehicle assault schools and more. However, in all that time I’d never been to a school that required me to not only “handle the threat,” but also tend to the wounded.
In today’s world of terrorist attacks, active shooters in schools (or malls or office buildings), workplace violence and other threats, all of which we’ve seen in the past twelve months, it behooves us to prepare ourselves to do more than just shoot back. Don’t get me wrong. Shooting back is good. In fact, superior firepower is the first best step in TCCC performance. That said, we have to recognize reality: sometimes the needed trauma / emergency first-aid care doesn’t involve having to shoot back first. The example I’d give you is the Boston Marathon bombing incident. Plenty of people needed emergency medical care – but as far as anyone knew, there was no attacker to shoot back at. No shots had been fired.
What do you do in such a situation? Do you know? If you KNOW what to do, do you regularly carry the necessary tools and supplies to perform the emergency medical functions?
Like I said, I’ve had plenty of first-aid training across the years and I felt fairly confident (going into the class) that I’d know what to do if someone needed emergency medical assistance for whatever reason. For years I’ve carried a small trauma pack with what I felt were the necessary supplies; and I was right about those necessary supplies if I based my judgment on the movies or what I was taught 30 years ago. A lot has changed in 30 years and NOTHING in the movies… well, very little in the movies is ever portrayed accurately.
Now, before I go into some of the basics of what we learned, let me throw out a few caveats:
First, a TCCC course doesn’t make you an EMT or a combat medic. It’s not meant to.
Second, SHOOTING is an intricate part of the course, so if you haven’t mastered basic marksmanship skills, then do that before taking a TCCC course.
Third, be honest with yourself: If you aren’t going to have the motivation and take the initiative to help someone (or yourself) in a high threat situation, don’t take up a space in this class that someone else could use.
Fourth, vet your instructor(s). I was fortunate in that I already personally knew Mr. Tom Perroni, the owner/operator of the Commonwealth Criminal Justice Academy, and I am well aware of his emergency medical training and operations background. His instructor cadre is top notch and they all teach with a passion that is obvious. I know other instructors though, that went and took a 2-day TCCC course someplace else and then added TCCC to the list of schools they teach. BE CAREFUL about where you get your training.
Now, with that out of the way, let me share a small piece of what I learned. As I said, I’ve had my share of first-aid training over the years. “A-B-C” was always an easy acronym to remember. Airway – Bleeding – Circulation. Make sure the patient/victim could breath, stop/control any bleeding and make sure the blood still in them as circulating (they had a heartbeat or you were performing CPR).
Remembering that TCCC deals with treating casualties under fire, the acronym is different but the priorities remain (mostly) the same. The new acronym I learned was M-A-R-C-H. It stands for:
Massive Bleeding: This is the only thing we deal with in an unsecured area and even then we don’t touch it until the immediate threat has been neutralized.
Airway: The victim/patient HAS to be able to breath. I’d had limited experience inserting an airway (nasal pharyngeal airway or NPA) but students in the class were able to do this on a training mannequin.
Respiration: Once the airway is clear then you check to see what the respiration rate is. An accelerated respiration rate can be indicative of excessive bleeding and/or shock. If you’ve controlled any massive bleeding that is externally visible, a higher respiration rate may indicate an internal bleed (from what I understood).
Circulation: Within the confines of whatever treatment you’ve provided (such as a tourniquet), you should be able to get a pulse if the patient’s blood pressure is sufficient.
Hypothermia / Head Injury: Something I hadn’t ever heard before but was taught in TCCC was that it’s vitally important to keep the patient’s core temperature up. If it drops below 90 degrees Fahrenheit, a 100% mortality rate has been observed. The last thing we’re checking for is head injury.
The course covered much more but there’s no way I can include it all here. Students learned how to insert a needle into the thoracic cavity to relieve tension pneumothorax. Students learned how to effectively apply a chest seal for entry and exit wounds due to gunshot or other penetrating wound. Students learned how to quickly and efficiently look for bleeding injuries including gun shots from calibers small enough that the skin closed back up. Students learned how to apply a cervical collar, load a patient onto a litter and methods for safely moving the litter away from the danger zone / farther into safe area or to the mode of transport.
The bottom line is that I feel much more confident, having had this training, than I did before taking it. I also am more familiar with the most common medical challenges gunshot wounds to the torso can cause and how easily they can be remedied until such time as a surgeon can fix the problem long term. As a person who carries a gun day in and day out, and being aware of the fact that trauma injuries can happen anywhere from a wide assortment of unexpected causes, I feel better prepared in my day for having successfully completed this training.
That said, the training is for naught if I don’t carry the necessary tools with which to deliver the skills I learned in this course. That means that I should always have with me or immediately available my gun and extra magazine(s) FIRST and FOREMOST. I also need to have a chest seal (or two), hemostatic gauze, a tourniquet, an appropriate needle for relieving tension pneumothorax, an NPA, gloves and a few other small items. All of this can be carried in a pouch small enough to fit in a cargo pocket, briefcase, backpack, etc. The key is HAVING it and knowing where it is when you need it. Sound familiar? It should. It’s the same rule that applies to carrying your gun.
The bottom line is that this type of course can prove invaluable at some unknown point in your future. I highly encourage everyone to take such a course. If you’re interested in taking the class from the Commonwealth Criminal Justice Academy, just visit their website, check out their training calendar and get signed up.