After providing care while under simulated enemy fire two Portuguese Force Protection Soldiers and Tactical Combat Casualty Care students rush a “patient” towards a Casualty Collection Point (CCP), during a Tactical Combat Casualty Care field exercise in Kabul, Afghanistan, June 22, 2018. TCCC training is designed to provide first responders with battlefield lifesaving skills while deployed to Afghanistan. (NATO photo by U.S. Army Master Sgt. Felix Figueroa)
By: Master Sgt. Felix Figueroa, NATO Special Operations Component Command-Afghanistan Public Affairs
KABUL, Afghanistan – A medical team from the 224th Area Support Medical Company, Maryland Army National Guard, provided training in Tactical Combat Casualty Care (TCCC) to NATO-led Resolute Support members at Kabul International Airport in June.
The team is assigned to the airport’s Role 2 hospital, which provides routine and preventative medical care and emergency surgery.
"Military medics are in high demand and limited. Therefore, TCCC training for non-medical personnel is not only important; it’s critical,” said U.S. Army Capt. Michelle Levesque, a Tactical Combat Casualty Care instructor.
Levesque, a hand surgery specialty physician’s assistant in Baltimore, Maryland, has dealt with a wide range of medical emergencies, from gunshot wounds to complete amputations and other upper-extremity traumas. She said her civilian experiences, coupled with her military training, enable her to plan, oversee and implement realistic combat-based Tactical Combat Casualty Care training.
"The goal of TCCC is to identify and treat those casualties with preventable causes of death and keep them alive long enough to reach a hospital,” said Levesque.
Levesque added that during her time at the airport’s Role 2 hospital, she and her team provided Tactical Combat Casualty Care training every month to local service members, along with diverse groups such as force protection teams, Train, Advise and Assist Command-Air (TAAC-Air), and members with the 1st Security Force Assistance Brigade (SFAB).
Those participating in the training learned and were tested on: treating severe bleeding (hemorrhaging), tourniquet application, clearing and protecting the airway, treatment for penetrating chest wounds and on-scene safety.
After two days of classroom hands-on learning and step-by-step instructions, students donned
body armor and tested their skills in a short field exercise, moving as a tactical unit through a training village within the base perimeter. Hospital staffers dressed as enemy role-players ambushed the Tactical Combat Casualty Care students, requiring them to establish perimeter security measures, conduct follow-on casualty assessments and move to a Casualty Collection Point (CCP) where they were assessed on their newly acquired life-saving skills.
"Although this is my first deployment as a firefighter, I am an EMT [Emergency Medical Technician] back home in Annapolis,” said U.S. Army Spc. Bradley Boucher, a Tactical Combat Casualty Care instructor. "I know all too well what it takes to get through a surreal and life-threatening situation.”
While instructing the students, Boucher recalled one of his first calls as an Emergency Medical Technician; responding to a domestic incident resulting in two gunshot victims. One of the gunshot victims died on the way to the hospital due to the severity of the wounds he sustained and the severe hemorrhaging accompanying it. The purpose of Boucher’s story was to emphasize to the students the importance of controlling blood loss.
Another instructor, who has deployed multiple times to Afghanistan, used his experiences as a Romanian Special Forces nurse to illuminate lessons for Tactical Combat Casualty Care students deployed for the first time.
"I’ve experienced my fair share of action against enemies of Afghanistan, witnessing many battlefield related wounds and injuries,” said Romanian Plutonier Ionut Amnar, a senior noncommissioned officer and Romanian Special Forces nurse at the Role 2 hospital. "As a result, I stress to TCCC students the importance of stopping catastrophic bleeding, clearing and securing the airway, and respiration management.”
"The training provided to our NATO partners is designed to empower them, increase situational awareness and ensure survivability while out on missions,” said U.S. Army Capt. Anne Alvarado, the Role 2’s hospital commander. "TCCC training provides all of that, along with peace of mind through confidence, knowing you can save a life.”
Tactical Combat Casualty Care was designed in the mid-1990s for the Special Operations medical community and created custom guidelines for preventable causes of death on the battlefield, such as hemorrhaging and airway obstruction based on injury patterns from previous conflicts. Adopted by U.S. Special Operations Command in 2005, TCCC is now used widely throughout the U.S. military, the civilian sector and allied nations.
According to the National Association of Emergency Medical Technicians (NAEMT), almost 90 percent of American service members who die from combat wounds, die before arriving at a medical treatment facility. While the statistic is staggering, it illustrates the vital importance of first responders –medics, corpsmen, and other medical practitioners – on the battlefield today.
The medical team that provided the training agree, and are quick to point out a line in their Tactical Combat Casualty Care learning manual that reads, "The fate of the injured often lies in the hands of the one who provides the first care to the casualty.”
Established in 2015, Resolute Support (RS) is a NATO-led, non-combat mission to train, advise and assist the Afghan National Defense and Security Forces (ANDSF), who assumed nationwide responsibility for Afghanistan’s security following the conclusion of the previous NATO-led International Security Assistance Force (ISAF) mission. Its purpose is to help the Afghan security forces and institutions develop the capacity to defend Afghanistan and protect its citizens in a sustainable manner.