TCCC, as a formalized set of guidelines and subsequent evolvement into a curriculum began with the 1996 publication of the first set of TCCC Guidelines in an article by CAPT Frank Butler.26 But many of the concepts and experiences that led to that publication occurred in the years prior and drew from articles and research that dated back as far as our previous conflicts but was never institutionalized.27,28

In the late 1990s, these concepts of TCCC were presented to the Joint Staff Surgeon and subsequently to senior leaders of the Military Health System, but no specific plan of action emerged from the briefings. They were also presented at a series of both military and civilian medical conferences, but there was no DoD-level effort to revamp prehospital combat casualty care practice.29

However, the Naval Special Warfare Command, the 75th Ranger Regiment, the Army Special Missions Unit, and the Air Force pararescue community all individually adopted the guidance and were the only units implementing the Guidelines at the start of the war in Afghanistan.30 Afterwards, as we just mentioned, the concepts and guidance spread from these innovative units to the general purpose forces, and most recently has been adopted as the standard of care for medical training for all Service members, Combat Lifesavers, and medical personnel.

In 2001, a medical research effort by the U.S. Special Operations Command (USSOCOM) led to the development of a Committee on TCCC (CoTCCC), which was first established at the Naval Operational Medicine Institute. A significant aspect of the committee composition is that 30% of the voting members should be comprised of active or former combat medics and paramedics, corpsmen, and pararescuemen (PJs). The remainder of the 42-person voting membership includes all Services, various surgical specialties, emergency medicine and combat medical educators, including physicians, physician assistants, nurses and medical planners.

After several years as a research-funded activity, the CoTCCC was moved to the Defense Health Board in 2007 and subsequently to the Joint Trauma System (JTS) in 2013 after it was formally established.31 Although the JTS has been realigned a few times since 2013, CoTCCC has remained a primary JTS committee and priority throughout its evolution.

The CoTCCC mission is “To develop on an ongoing basis the best possible set of trauma care guidelines customized for the tactical environment and to facilitate the transition of these recommendations into battlefield trauma care practice.”32 Guideline updates have occurred periodically since 1996, the first time in 200333 up through the most recent version released in November of 2020. In addition to routine meetings involving the entire COTCCC membership, subcommittees and specialized ad hoc groups are formed, as needed, to address specific issues that may ultimately be presented to the larger group for consideration.