Once a plan exists for when and how to perform TC, medical teams must train in realistic scenarios that require TC use to ensure this capability is available and easily utilized when needed. Given a variety of constraints in time, Class VIII (medical material equipment, consumables, blood), funding, and personnel, most medical training focuses on managing common casualties in typical operating contexts. These scenarios rarely require LCs to engage in TC because the scenarios do not outstrip their level of training or resource availability. TC, in its current form, is an ALTERNATE care plan for prolonged casualty care (PCC) or unusual cases that exceed PRIMARY plans. Therefore, training must include unexpected scenarios that require KSAs that are unavailable to the trainees and cannot be reasonably obtained by them prior to a deployment or within their scope of practice, and thus require them to call for help from a RE. Examples include:

- Medics/corpsmen managing a burn patient over time, especially if needs include an escharotomy and advanced airway management.
- Role 1 providers managing severe community acquired pneumonia that requires mechanical ventilation or a patient with an extremity injury that requires fasciotomy.
- Role 2 surgical team managing a casualty with a head injury that requires neurosurgical input and a decompressive craniectomy or a septic patient that develops the acute respiratory distress syndrome.
- Role 3 team managing a local national with an infection caused by a highly drug resistant organism, or a patient with acute kidney injury that requires renal replacement therapy, or a burn patient with severe inhalation injury.

Recognize

Culturally, the U.S. Military trains medical providers to succeed on their own merits; we validate individuals, not their ability to perform tasks or manage casualties as teams. Consequently, one of the hardest aspects of TC is for LCs to recognize when they should call for help. When a healthcare provider is uncertain about a casualty’s diagnosis or the best management plan, s/he should consider calling for help. Because there is no single-entry point for TC within the OVH system, LCs must first determine the urgency of the consultation and then conduct TC using the appropriate technology. The OVH system is divided into routine TC and urgent/emergent TC, and direct patient care. Table 2 on the next page highlights these TC pathways and when LCs should use one or the other.