Chapter 1. 전술적 전투 사상자 처치(TCCC) 개요 

소개

TCCC의 필요성과 지혈대의 재검토

CoTCCC와 TCCC 특별 조사 위원회

2018년의 전투 현장 외상 처치

이라크와 아프가니스탄 전투 현장에서 TCCC의 활용 사례

전장 외상 처치

미 국방성의 TCCC(2019년도)

이라크와 아프가니스탄의 전쟁터에서 전 세계로 사용

요약

참고 문헌

Chapter 2 교전 중 처치(CUF)

소개

전투 현장에서 부상자 이동하기

출혈 조절

기도

요약

참고 문헌

Chapter 3 전술적 현장 처치(TFC)

소개

안전한 경계 구역 구축

의식 상태가 변화된 부상자의 무장 해제 및 통신 장비 확보

대량 출혈

기도

호흡/환기

산소 투여

저체온증 예방

관통성 눈 손상

진통제

항생제

의사소통

심폐소생술

처치에 대한 기록

후송을 위한 사상자 준비

사상자 이동

부상을 입은 적의 전투원

전술적 후송 요청(TAECVAC)

TCCC에서 개선할 기회

참고 문헌

Chapter 4 전술적 후송 처치(TEC)

소개

전술적 후송 처치 대 전술적 현장 처치

2012년 국방 보건위원회(DHB)의 전술적 후송 처치 권장 사항

전술적 후송 처치의 특별한 방향

요약

참고 문헌

Chapter 5 시나리오

소개

시나리오1: 야간 정찰 중에 발생한 총상

시나리오2: 도시 정찰 중 로켓 추진식 수류탄(RPG) 공격

시나리오3: 호송 차량 이동 중 로켓 추진식 수류탄(RPG) 공격

시나리오4: 사제폭발물 장치 공격

시나리오5: 시가지에서 패스트로프 하강 중에 발생한 부상자

참고 문헌

Chapter 6 전투 현장에서 항공 후송

소개

전술 후송(TACEVAC) 처치

의료치료시설에서 의료치료시설로 의무 후송

항공 후송

요약

참고 문헌

Chapter 7 합동 외상 체계(JTS)와 군대의 처치 역할

소개

합동 외상 체계와 국방부 외상 등록 체계

예방

전장 손상 처치 능력

지속적인 처치

요약

참고문헌

Chapter 8 전술적 전투 사상자 처치에서 중증도 분류

소개

TCCC에서의 중증도 분류

전투 중증도 분류 결정 알고리즘

계획 및 보호

요약

참고 문헌

Chapter 9 폭발물에 의한 손상

소개

개요

폭발물

결과를 악화시킬 수 있는 요인

손상의 유형

중증도 분류

폭발 손상 분류에 따른 평가와 처치

특별히 고려할 사항

정신과적 고려사항

증거

요약

참고 문헌

Chapter 10 전술적 전투 사상자 처치에서 화상 부상자 치료

소개

초기평가

화상 상처의 신체적 특성

화상으로 인한 손상에 대한 수액 소생술

상처의 치료

화상 환자 후송

미 육군 외과 연구소 화상 항공 이송팀

요약

참고 문헌

Chapter 11 전술적 전투 사상자 관리에서 부상자 대응 계획

소개

사상자 대응 체계

배치 전 요구 사항

의학적 위협 평가

사령부의 명령 및 지침

의료 자산 평가

전술 의료지원 계획 개발

요약, 예행연습 및 전투 전 점검

사상자 수집소 운영

사후 검토

요약

참고 문헌

Chapter 12 도시지역 작전에서 의료지원

소개

도시의 지형

도시지역 전투의 특성

사상자

도시지역 전투에 대한 의료 준비

미래

요약

참고 문헌

Chapter 13 전투 의무요원의 윤리적 고려사항

소개

분쟁의 윤리

윤리와 전쟁 포로

부상을 입은 적의 전투원 관리

요약

참고 문헌

Index

[서문]

If you are a combatant wounded on the battlefield, the most critical phase of your care is the period from the time of injury until the time that you arrive at a surgically capable medical treatment facility (MTF). Almost 90% of American service men and women who die from combat wounds do so before they arrive at an MTF, thus highlighting the importance of the battlefield trauma care that is provided by our combat medics, corpsmen, and pararescuemen (PJs), as well as by the casualties themselves and their fellow combatants.

Most of the U.S. military went to war in Afghanistan and Iraq with battlefield trauma care strategies that were not based on Tactical Combat Casualty Care (TCCC)-medics in 2001 had no tourniquets, no hemostatic dressings, no intraosseous devices, and Civil War-vintage analgesia (IM morphine) and treated hemorrhagic shock with large-volume crystalloid fluid replacement.

Only a select few Special Operations and conventional units went to war with a robust TCCC capability. The 75th Ranger Regiment, for example, taught the concepts of TCCC to everyone in the Regiment as part of their TCCC-based Casualty Response Plan. As a result, the Regiment documented a preventable prehospital death rate of 0%, an unprecedented success in optimizing casualty survival on the battlefield. In contrast, the overall incidence of preventable prehospital deaths among U.S. combat fatalities was 24%, as documented by Col. Brian Eastridge in his landmark 2012 paper.

Once the U.S. Special Operations Command mandated that TCCC would be used in all of its units, the rest of the U.S. military began to take notice and to follow that example. As a result, prehospital trauma care in the military has undergone an unprecedented transformation since the beginning of the conflicts in Afghanistan and Iraq. A 2018 U.S. Department of Defense Instruction has officially established TCCC as the standard for battlefield trauma care in the U.S. military and requires that all service members receive TCCC training as appropriate for their role in helping to provide this care.

Combat medical personnel in the U.S. military (and those of most of our coalition partners) are now trained to manage combat trauma on the battlefield using the TCCC Guidelines. TCCC started as a biomedical research project in the U.S. Special Operations Command (USSO COM). The largely tradition-based trauma care practices that were in place in 1993 were systematically re-evaluated. Many aspects of prehospital care were found to not be well supported by the available evidence and in need of revision. TCCC was introduced as a new framework on which to build trauma care guidelines customized

for the battlefield. The original TCCC paper came out in Military Medicine in 1996 and provided a foundation, but TCCC has evolved steadily over the past 18 years and will always be a work in progress. These trauma care guidelines customized for use on the battlefield are now reviewed and updated by the Committee on TCCC (CoTCCC) on an ongoing basis. The CoTCCC is composed of trauma surgeons, emergency medicine physicians, combatant unit physicians, and combat medics, corpsmen, and PJs. There are also physician assistants and military medical educators among the members. At present the CoTCCC has representation from all of the U.S. armed services, and 100% of the voting membership has experience deploying in support of combat operations.

The CoTCCC was first located at the Naval Operational Medicine Institute (NOMI) through the leadership of Capt. Doug Freer, the Commander, and Capt. Steve Giebner, the first Chairman of the group. It remained at NOMI for 7 years before being relocated to become Defense Health Board in 2008. In 2013, the CoTCCC was moved again to function as part of the Joint Trauma System, which is in turn part of the Combat Support Directorate at the Defense Health Agency.

Changes in the TCCC Guidelines are based on direct input from combat medical personnel, an ongoing review of published prehospital trauma care literature, new research coming from military medical research organizations, lessons learned from U.S. and allied service medical departments, and trauma conferences conducted by the Joint Trauma System and the Armed Forces Medical Examiners System.

The CoTCCC publishes its recommendations in both the Journal of Special Operations Medicine and the Prehospital Trauma Life Support Textbook. The TCCC Guidelines are the only set of battlefield trauma care best-practice guidelines to have received the triple endorsement of the American College of Surgeons Committee on Trauma (ACS-COT), the National Associations of Emergency Medical Technicians (NAEMT), and the Department of Defense (DoD).

As the CoTCCC has continued to work to improve battlefield trauma care, it has formed strategic partnerships with other organizations that seek to improve prehospital trauma care in non-combat settings. TCCC began its partnership with the Prehospital Trauma Life Support (PHTLS) Committee in 1998 and continues to work with this internationally recognized group of leaders in prehospital trauma care. The PHTLS organization teaches TCCC courses around the world and has recently established a program to provide TCCC training to law enforcement agencies and the militaries of allied countries when these groups request it.

TCCC established a strategic partnership with the U.S. Army Institute of Surgical Research (USAISR) in 2004. At the request of USSOCOM, USAISR undertook the first preventable death review on all Special Operations fatalities from Afghanistan and Iraq that had occurred from the start of the conflict in Afghanistan until November 2004, which helped to highlight the criti\-cal need for all combatants to be trained in basic TCCC interventions. The USAISR subsequently developed a research effort with a strong focus on battlefield first responder care and published