Committee on Tactical Combat Casualty Care (CoTCCC)

#### CoTCCC Mission Statement

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.

The Committee on Tactical Combat Casualty Care (CoTCCC) is the Prehospital arm of the Joint Trauma System for the Department of Defense.

The CoTCCC is composed of 45 voting members specially selected as subject-matter experts in trauma, battlefield medicine, tactical medicine, prehospital medicine, and their experience in the deployed combat environment. The TCCC Collaboration Group is composed of the CoTCCC and hundreds of subject-matter experts across many domains and liaisons from DoD, Government and Partner nation organizations.

The CoTCCC and the TCCC Collaboration Group focus all their efforts on providing the best recommendations for training and equipment for our individual service members, combat medics, corpsman, pararescue, and med techs going into harm's way around the world.

#### CoTCCC History

The need for periodic updates to the TCCC guidelines was recognized in the initial TCCC paper, which recommended that the TCCC guidelines be updated as needed by a Department of Defense-sponsored committee established for this purpose. This concept was endorsed by the US Special Operations Command (USSOCOM), and the Committee on Tactical Combat Casualty Care (CoTCCC) was subsequently funded in 2001 as a USSOCOM Biomedical Research Program. The command that volunteered and was selected to execute this project, the Naval Operational Medicine Institute, with the leadership of Navy Captains Doug Freer and Stephen Giebner, also conducted the necessary coordination with Navy Medicine leaders to ensure that there would be long-term support of the newly-established CoTCCC. BUMED programmed for financial and personnel support of the CoTCCC beginning in fiscal year 2004. In fiscal years 2007 through 2012, the Office of the Surgeon General of the Army, the US Army Institute of Surgical Research, and the Defense Health Board also provided substantial support for the CoTCCC.

#### CoTCCC Membership

Since the goal of TCCC is to provide the best possible medical care consistent with good small-unit tactics, it was and is essential that the membership of the CoTCCC include combat medical personnel as well as physicians. It is also critical to have tri-service representation to ensure that differences in doctrine and experience between the Army, Navy, and Air Force medical departments are identified and best prehospital trauma care practices from each incorporated into TCCC. The combat medics selected for the CoTCCC included Navy SEAL corpsmen, Navy corpsmen assigned to Marine units, Ranger medics, Special Forces 18-D medics, Air Force pararescuemen (PJs), Air Force aviation medics, and Coast Guard health specialists. Physician membership included representatives from the trauma surgery, emergency medicine, critical care, and operational medicine communities. Physician assistants, medical planners, and medical educators were also represented.

As the use of TCCC spread from the US Military to other agencies within the Federal government, to allied nations, and to the civilian sector, it became important to include representatives from these groups in the TCCC update process, both to secure the benefit of their input and to facilitate communication between them and the CoTCCC. Accordingly, the CoTCCC began to invite liaison members from these groups to participate in its combat trauma care performance improvement process. The CoTCCC voting members and CoTCCC liaison members collectively comprise the TCCC Collaboration Group and it is through the untiring efforts of this group that the TCCC Guidelines and other TCCC knowledge products remained state of the art through 16 years of conflict.

#### CoTCCC Alignment

In 2007, due to the increasing visibility and success of TCCC in the Global War on Terrorism (GWOT), the Navy Medical Support Command proposed that the CoTCCC be moved to a more senior joint command. This proposal was briefed to the offices of the Assistant Secretary of Defense for Health Affairs and the Surgeon for the Joint Chiefs of Staff. In March 2008, the CoTCCC was relocated to function as a working group of the Trauma and Injury Subcommittee of the Defense Health Board (DHB). The DHB is chartered to provide independent advice and recommendations on medical issues to the Secretary of Defense through the Under Secretary of Defense for Personnel and Readiness and the Assistant Secretary of Defense for Health Affairs, including recommendations regarding the care of U.S. service members wounded in combat operations. Five years later, on 21 February 2013, by Direction of the Acting Undersecretary of Defense for Personnel and Readiness, the CoTCCC was moved once more, this time to the Joint Trauma System (JTS) to have it co-located with the DoD’s combat trauma management system. In 2017, Congress made the Joint Trauma System the DoD’s lead agency for trauma, and the CoTCCC is the prehospital component of the Joint Trauma System’s Defense Committee on Trauma (DCoT).