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Twenty-five medics and corpsmen who had managed casualties on the battlefield were selected to present at the conference.  Each of the presenters provided an account of their casualty scenario followed by their thoughts about lessons learned and what could be done to improve battlefield trauma care.  The audience was composed of approximately 80 invited individuals with a special interest in the area of tactical trauma care who contributed to the discussions that followed each presentation.  The summarized key points from the conference are shown below.

Tactical Combat Casualty Care
First Responder Conference
9-11 September 2008
Quick-Look Summary
1. The techniques taught in TCCC are being widely used on the battlefield and are in general working well.  Tourniquets are the single most important life-saving intervention performed by corpsmen and medics.  Further, the incidence of complications resulting from tourniquet use has been documented in several recent studies to be very low.

2. Training and equipping of medics, combat lifesavers, and other combatants to perform TCCC varies widely among the different services.

3. TCCC must have strong support from military line commanders to be optimally employed.  An introduction to the basic principles of TCCC as well as the need for well-developed and rehearsed tactical response plans for casualty scenarios should be included in the training for combat leaders.  Ideally, it should be provided at both entry and command level courses for line officers and NCOs.  This will help combat mission commanders to understand that battlefield trauma care is very different from civilian prehospital trauma care.  Some interventions expected as a standard of care by many non-medical individuals, including commanders, (e.g. the practice of starting IV lines on every casualty) are not appropriate in a tactical setting.  Combat leaders need to understand combat medicine.

4. The medics and corpsmen present at the conference emphasized the importance of training non-medical personnel to perform key life-saving interventions such as tourniquet placement, basic airway management, and use of hemostatic agents.  Combat Lifesavers are essential, especially when there are multiple casualties to treat, when the corpsmen or medic is among the injured, or when there is no corpsman or medic present at the scene of the casualty.

5. One excellent example of success in combat trauma management is the 75th Ranger Regiment.  The medical leadership there has successfully obtained command support for TCCC in the regiment and constructed a program that: 1) provides tiered TCCC training for every person in the Regiment; 2) conducts combat casualty drills as part of the units' tactical training; 3) aggressively incorporates medical considerations into mission planning; 4) includes a working system for documentation of TCCC care on the battlefield; and 5) maintains this data in a unit trauma registry. The success of these efforts has been remarkable.  Despite having sustained 482 casualties in Iraq and Afghanistan as of 28 August, 2008 (including 31 fatalities), there were no preventable deaths identified in Ranger units in a recent review of their casualty data - a truly remarkable achievement seven years into this war.

6. The TCCC research priorities identified at the conference were:

7. Live tissue training was considered to be a very valuable element of combat trauma training by the attendees.  To paraphrase the words of one participant: taking care of wounded casualties on the battlefield should not be the first time that our combat medical personnel see or deal with severe bleeding.  Until a simulation technique is developed that is documented to equal the benefit of live tissue training in preparing medics to manage combat trauma, appropriately conducted live tissue training should be supported as an essential component of combat medic training.