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Tactical Combat Casualty Care for SOF Operators

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Title: Tactical Combat Casualty Care for SOF Operators


1
Afternoon Two
Real World Tactical Scenarios Lessons learned
Scenarios (By audience) Exam and Review Course
feedback
2
Tactical Casualty Scenarios
  • If your combat trauma management plan doesnt
    work for the tactical situation, then for SOF
    combat medics - it doesnt work.
  • Dont want to trade one set of rigid guidelines
    for another
  • Scenario-based planning

3
Urban Warfare Scenario
4
Urban Warfare Scenario
  • 16 man Ranger team
  • 70 foot fast rope insertion for building assault
  • One man misses rope and falls
  • Unconscious
  • Bleeding from mouth and ears
  • Taking fire from all directions from hostile
    crowds

5
The Battle of Mogadishu
  • Most US casualties in a single firefight since
    Vietnam
  • US casualties 18 dead, 73 wounded
  • Estimated Somali casualties 350 dead, 500 wounded
  • Battle 15 hours in length

6
Mogadishu Complicating Factors
  • Helo CASEVAC not possible because of crowds,
    narrow streets and RPGs
  • Vehicle CASEVAC not possible because of ambushes,
    roadblocks, and RPGs
  • Gunfire support problems non-combatants, cover
    from buildings

7
Care under Fire
  • Return fire?
  • Move patient to cover right away or wait for long
    board?
  • How should he be moved?
  • Intubation?
  • IV fluids?
  • Urgency for evacuation?

8
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9
Wear your body armor!
10
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11
Shrapnel Stopped by Strike Plate
12
Even though it only caught the edge, the plate
stopped this piece of shrapnel
13
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14
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15
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16
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17
Wear your tactical eyewear!
18
EYE Protection WORKS!
19
NO eye protection
20
Eye Protection
No Eye Protection
21
Bilateral Eye Enucleation (Removal)
22
Authorized Ballistic Protective Eyewear Systems
23
Questions?
24
Scenario Discussions
  • Break into groups of 5 1 medical person to lead
    discussion
  • You are the one administering/in charge of
    treatment
  • 1 operator per scenario
  • 10 minutes per scenario

25
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26
Mogadishu - Scenario 7 Helo Hit by RPG
Round
  • Hostile and well-armed (AK-47s, RPG) urban
    environment
  • Building assault to capture members of a hostile
    clan
  • In Blackhawk helicopter trying to cover helo
    crash site
  • Flying at 300 foot altitude

27
Mogadishu - Helo Hit by RPG Round (cont)
  • Left door gunner with 6 barrel M-134 minigun
    (4000 rpm)
  • Hit in hand by ground fire
  • Another crew member takes over mini-gun
  • RPG round impacts under right door gunner

28
Mogadishu - Helo Hit by RPG Round (cont)
  • Windshields all blown out
  • Smoke filling aircraft
  • Right minigun not functioning
  • Left minigun without a gunner and firing
    uncontrolled
  • Pilot
  • Transiently unconscious - now becoming alert

29
Mogadishu - Helo Hit by RPG Round (cont)
  • Co-pilot
  • Unconscious - lying forward on helos controls
  • Crew Member
  • Leg blown off
  • Lying in puddle of his own blood
  • Femoral bleeding

30
Mogadishu - Helo Hit by RPG Round (cont)
  • YOU are the guy providing care
  • What do you do first?

31
Afghanistan
32
SEAL Casualty - Afghanistan
  • August 2002
  • Somewhere in Afghanistan
  • SEAL element on direct action mission
  • Story of the casualty as described by the first
    responder

33
SEAL Casualty - Afghanistan
  • There were four people in my team, two had
    been shot. Myself and the other uninjured
    teammate low crawled to the downed men. The man I
    came to was lying on his back, conscious, with
    his left leg pinned awkwardly beneath him. He was
    alert and oriented to person, place, time, and
    event. At that point I radioed C2 to notify them
    of the downed man.

34
SEAL Casualty - Afghanistan
  • Upon closer inspection, his knee was
    as big as a basketball and his femur had broken.
    The patient was in extreme pain and did not allow
    me to do a sweep of his injured leg. He would
    literally shove me or grab me whenever I touched
    his leg or wounds. I needed to find the entrance
    and exit wound and stop any possible arterial
    bleeding.

35
SEAL Casualty - Afghanistan
  • But there was zero illumination and he
    was lying in a wet irrigation ditch. So I
    couldnt see blood and I couldnt feel for
    blood.

36
SEAL Casualty - Afghanistan
  • We were also in danger because our
    position was in an open field (where the
    firefight had been) and I had to provide security
    for him and myself. So, I couldnt afford to turn
    on any kind of light to examine his wounds. I
    told him to point to where he felt the pain. He
    had to sort through his pains.

37
SEAL Casualty - Afghanistan
  • He had extreme pain in his knee and
    where his femur had been shattered as well as a
    hematoma at the site of the entrance wound
    (interior and upper left thigh). Finally, he
    pointed to his exit wound (anterior and upper
    left thigh). Again, I had no way of telling how
    much blood he had lost. But I did know that he
    was nonambulatory.

38
SEAL Casualty - Afghanistan
  • So I called C2 again. I gave him the
    disposition of the patient as well as a request
    for casevac, a corpsman, and additional personnel
    to secure my position and assist in moving the
    patient to the helicopter. I thought about moving
    the two of us to some concealment 25 meters away,
    but we were both really low in a shallow
    irrigation ditch. I felt safer there than trying
    to drag or carry a screaming man to concealment.

39
SEAL Casualty - Afghanistan
  • Between providing security and spending
    a lot of time on the radio I didnt get to treat
    the patient as much as I wanted to. I had given
    him a Kerlix bandage to hold against his exit
    wound. When he frantically told me that he was
    feeling a lot of blood, I went back to trying to
    treat him. I couldnt elevate his leg. To move it
    would mean hed scream in pain, which wasnt
    tactical.

40
SEAL Casualty - Afghanistan
  • There was just no way he would allow me
    to apply a pressure dressing to the exit wound
    even if I could locate it and pack it with
    Kerlix. So, I decided to put a tourniquet on him.

41
SEAL Casualty - Afghanistan
  • His wounds were just low enough on his
    leg to get the tourniquet an inch or so above the
    site. I had a cravat and a wooden dowel with 550
    cord attached to it to use as a tourniquet. I
    told him to expect a lot of pain as I would be
    tightening the cravat down.

42
SEAL Casualty - Afghanistan
  • At this point he feared for his life so
    he agreed. Once I got it tightened I had trouble
    securing it. The 550 cord was hard to get
    underneath the tightened cravat.

43
SEAL Casualty - Afghanistan
  • After over 5 minutes, the corpsman
    arrived along with a CASEVAC bird and a security
    force. Moving the patient was very hard. Four of
    us struggled to move him and his gear 25 meters
    to the bird. The patient was over 200 pounds
    alone and we were moving over very uneven
    terrain.

44
SEAL Casualty - Afghanistan
  • We wanted to do a three-man carry with
    two men under his arms and one under his legs.
    But again, his leg was flopping around at the
    thigh and couldnt be used to lift him.

45
SEAL Casualty - Afghanistan
  • The bird, (a TF 160th MH-60) had a 50-cal
    sniper rifle strapped down, which made it hard
    for us to get him in. It took us minutes to get
    him 25 meters into the bird. The corpsman went
    with my patient as well as the other downed man
    in my team and I went back to the op.

46
Ambush In Afghanistan
47
Ambush In Afghanistan
  • Small U.S. military outpost in a village in
    Eastern Afghanistan
  • Unpaved, rocky mountain road
  • 2 vehicles moving in a routine convoy to visit
    nearby town and buy fuel
  • Vehicle 1 - Two occupants
  • Vehicle 2 - Three occupant
  • No medics in convoy

48
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49
Ambush In Afghanistan
  • Decision Point
  • Should you wear seat belts in this type of a
    convoy?

50
Ambush In Afghanistan
  • Second vehicle struck by command-detonated IED
  • Flipped over on its roof
  • First car occupants uninjured

51
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52
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53
Ambush In Afghanistan
  • Decision Point for occupants of first vehicle
  • Treat the casualties or establish security?

54
Ambush In Afghanistan
  • You are the doctor at the outpost about 500 yds
    away holding clinic for the local Afghan
    children.

55
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56
Ambush In Afghanistan
  • You hear the explosion
  • Receive call that there are 3 people dead
  • ? other injuries
  • Body armor and weapon are several minutes away in
    other direction
  • Quick Reaction Force is gearing up

57
Ambush In Afghanistan
  • Decision Point
  • What do you do?
  • Get weapon and wait for QRF?
  • Get weapon and move on foot to crash site?
  • Grab trauma bag and move to crash site
    immediately?

58
Ambush In Afghanistan
  • Driver no seat belt
  • Conscious
  • Large facial laceration
  • Severe nose pain and bleeding
  • Neck pain
  • No back pain

59
Ambush In Afghanistan
  • Interpreter seat belt
  • Chipped tooth
  • Foreign military person
  • Large leg laceration bleeding heavily
  • Trapped in car
  • Moaning with pain
  • Struggling to get out of the collapsed,
    overturned vehicle

60
Ambush In Afghanistan
  • Decision Point
  • You are the driver of the ambushed vehicle.
  • Should you make the person stay in the car?
  • What to do next?

61
Ambush In Afghanistan
  • Driver helps extract injured passenger
  • Doctor arrives on the scene a few minutes later
  • Individual with leg laceration already taken by
    truck to village
  • Treating the driver

62
Ambush In Afghanistan
  • Decision Point
  • How to treat the injured driver?
  • Long spine board?
  • C-collar?
  • Try to close facial wound?

63
Ambush In Afghanistan
  • Follow-up on the casualty that left the scene
  • Brought back about 40 minutes later
  • No respirations/HR
  • Fixed and dilated pupils
  • No obvious head injury (no Battles sign)
  • No obvious step-offs in neck

64
Ambush In Afghanistan
  • Decision Point
  • Should you start CPR?

65
Ambush In Afghanistan
  • Transport casualties to HLZ

66

67
Questions?
68
CQB Scenario
  • A SOF element is moving on a high-value target in
    an urban environment
  • The first two men in a 8-man train are shot by
    an individual with an automatic weapon while
    moving down a hallway.
  • The attacker follows this burst with a grenade.

69
CBQ Scenario (2)
  • One operator is shot in the abdomen but
    conscious.
  • The second casualty is shot in the shoulder area
    with severe external bleeding.
  • The third operator is unconscious from the
    grenade blast.
  • The attacker withdraws around a corner.

70
CBQ Sceanrio (3)
  • Tactical actions
  • Medical considerations
  • Abdominal wound
  • Shoulder wound
  • Unconscious casualty

71
Tactical Combat Casualty Care
  • Casualty scenarios in Special Operations usually
    entail both a medical problem and a tactical
    problem.
  • Emergency action must address both problems at
    the same time.
  • INCLUDE MEDICAL ELEMENT IN OPS PLANNING!

72
Scenario-Based Planning
  • Consider management plans for combat trauma to be
    advisory rather than directive in nature.
  • Rarely will an actual tactical situation exactly
    reflect the conditions outlined using such
    scenarios.
  • Need to go beyond a by the numbers mentality

73
TCCC Objectives
  • Treat the casualty
  • Prevent additional casualties
  • Complete the mission

74
  • Lessons from the Front
  • Feedback from docs and medics based on their
    experiences treating casualties in OIF/OEF

75
JDAM 1
76
JDAM 2
77
JDAM 3
78
Ranger 1
79
Ranger 2
80
Ranger 3
81
Ranger 4
82
Ranger 5
83
Ranger 6
84
Ranger 7
85
Ranger 8
86
CASEVAC Doc in Iraq
  • If you are in a SOF unit and you are shipping a
    wounded detainee for care ALWAYS send a
    security detachment to guard the detainee.

87
TCCC in IRAQ
  • The adoption and implementation of the
    principles of TCCC by the medical platoon of TF
    1-15 IN in OIF 1 resulted in overwhelming
    success. Over 25 days of continuous combat with
    32 friendly casualties, many of them serious, we
    had 0 KIAs and 0 Died From Wounds, while
    simultaneously caring for a significant number of
    Iraqi civilian and military casualties.

88
TCCC in IRAQ (cont)
  • This success should serve as a model for other
    conventional combat units throughout the army
    involved in Level 1 treatment.
  • The principles of TCCC are well-researched and
    proven effective and should be the foundation of
    the treatment of battlefield casualties.
  • CPT Michael Tarpey
  • Battalion Surgeon 1-15 IN
  • 20 January 2005

89
The End
The End
90
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