The need for periodic updates to the TCCC Guidelines was recognized early in the development of TCCC. The original TCCC paper recommended that the TCCC Guidelines be updated as needed by a DoD-sponsored committee established for this purpose.5 This concept was endorsed by the U.S. 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 chosen to execute this project, the Naval Operational Medicine Institute, subsequently conducted the necessary coordination with Navy medicine leaders to ensure that there would be long-term support of this effort. BUMED programmed for financial and personnel support of the CoTCCC beginning in fiscal year 2004. In fiscal years 2007 through 2009, the Office of the Surgeon General of the Army, the U.S. Army Institute of Surgical Research, and the Defense Health Board (DHB) also provided substantial support for the CoTCCC.
Because the goal of TCCC is to provide the best possible medical care consistent with good small-unit tactics, it 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 practices from each are incorporated into TCCC. The combat medics selected include Navy SEAL corpsmen, Navy corpsmen assigned to Marine units, Ranger medics, Special Forces 18-D medics, Air Force pararescuemen, Air Force aviation medics, and Coast Guard health specialists. Physician membership includes representatives from the trauma surgery, emergency medicine, critical care, and operational medicine communities. Physician assistants, medical planners
In 2007, due to the increasing visibility 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 to the Secretary of Defense through the Under Secretary of Defense for Personnel and Readiness and the Assistant Secretary of Defense for Health Affairs on medical issues, including the care of U.S. service members wounded in combat operations.
Later, on 21 February 2013, by Direction of the Acting Under Secretary 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 JTS the DoD’s lead agency for trauma, and the CoTCCC is the prehospital component of the JTS.
Since 2001, and throughout these organizational changes, the CoTCCC has continued to monitor developments in prehospital trauma care. The TCCC Guidelines are updated based on: (1) ongoing review of the published civilian and military prehospital trauma literature; (2) ongoing interaction with military combat casualty care research laboratories; (3) direct input from experienced combat corpsmen, medics, and PJs; (4) input from the service Medical Lessons Learned Centers; (5) case reports discussed at the weekly Joint Theater Trauma System (JTTS)process improvement video teleconferences; (6) observations on the causes of death in combat fatalities gleaned from JTS-Armed Forces Medical Examiner System (AFMES) conferences; and (7) expert opinion from both military and civilian trauma experts.
Each change to the TCCC Guidelines is now supported by a change paper published in the Journal of Special Operations Medicine. Guideline changes are also included in revisions of the PHTLS textbook.21,22
As the use of TCCC spread from the U.S. military to other agencies within the federal government, allied nations, and 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 Working Group, and it is through the untiring efforts of this group that the TCCC Guidelines and other TCCC knowledge products have remained state of the art through 16 years of conflict.8,21
Although the TCCC Guidelines are best-practice trauma care guidelines customized for use on the battlefield, they are only guidelines. There are no rigid protocols in combat, including TCCC. If the recommended TCCC combat trauma management plan does not work for the specific tactical situation that a combat medic, corpsman, or PJ encounters, then care must be modified to best fit the tactical situation. Scenario-based planning, then, is critical for success in TCCC.5,13