Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators

Abstract Introduction The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Ca...

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Veröffentlicht in:Military medicine 2020-08, Vol.185 (7-8), p.e1271-e1276
Hauptverfasser: Scott, Stephen M, Carman, Margaret J, Zychowicz, Michael E, Shapiro, Mark L, True, Nicholas A
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container_end_page e1276
container_issue 7-8
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container_title Military medicine
container_volume 185
creator Scott, Stephen M
Carman, Margaret J
Zychowicz, Michael E
Shapiro, Mark L
True, Nicholas A
description Abstract Introduction The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations. Materials and Methods This is a quality improvement pre–post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants’ self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard. Results A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = −11.29, p 
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Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations. Materials and Methods This is a quality improvement pre–post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants’ self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard. Results A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = −11.29, p &lt; 0.001. A paired t-test revealed a significant increase in exam scores from pre (M = 70.22, SD = 9.43) to post (M = 87.78, SD = 7.19), t (17) = −7.31, p &lt; 0.001. There was no pre-intervention skills assessment, however, all participants (n = 18, 100%) passed the tourniquet application, needle chest compression, and insertion of nasopharyngeal airway. Conclusion TCCC for Army Aviators is easily implemented, demonstrates an increase in knowledge and confidence in providing prehospital care, and provides effective scenario-based training of necessary psychomotor skills needed to reduce preventable death on the battlefield. TCCC for Army Aviators effectively takes the TCCC for All Combatants curriculum and modifies it to address the unique considerations in treating wounded aviators and passengers, both in flight and after crashes. This project demonstrates on a small scale how TCCC can be tailored to specific military jobs in order to successfully meet the intent of the upcoming All Service Member TCCC course mandated in DoD 1322.24. Beyond Army aviation, this program is easily modifiable for aviators throughout the military and civilian sector.</description><identifier>ISSN: 0026-4075</identifier><identifier>EISSN: 1930-613X</identifier><identifier>DOI: 10.1093/milmed/usz491</identifier><identifier>PMID: 32314785</identifier><language>eng</language><publisher>OXFORD: Oxford University Press</publisher><subject>Armed forces ; Casualties ; Clinical Competence ; Emergency medical care ; Emergency Medical Services ; General &amp; Internal Medicine ; Helicopters ; Hemorrhage - prevention &amp; control ; Humans ; Life Sciences &amp; Biomedicine ; Medicine, General &amp; Internal ; Military medicine ; Military Medicine - education ; Military Personnel ; Pilots ; Science &amp; Technology ; Wounds and Injuries - therapy</subject><ispartof>Military medicine, 2020-08, Vol.185 (7-8), p.e1271-e1276</ispartof><rights>Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2020</rights><rights>Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>1</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000569869400055</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c393t-97753849d279e96bfb9e0dac1c7ff53b2818dea3a9768d5ae18dc0978156e0d23</citedby><cites>FETCH-LOGICAL-c393t-97753849d279e96bfb9e0dac1c7ff53b2818dea3a9768d5ae18dc0978156e0d23</cites><orcidid>0000-0002-0400-0134</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,1585,27928,27929</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32314785$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scott, Stephen M</creatorcontrib><creatorcontrib>Carman, Margaret J</creatorcontrib><creatorcontrib>Zychowicz, Michael E</creatorcontrib><creatorcontrib>Shapiro, Mark L</creatorcontrib><creatorcontrib>True, Nicholas A</creatorcontrib><title>Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators</title><title>Military medicine</title><addtitle>MIL MED</addtitle><addtitle>Mil Med</addtitle><description>Abstract Introduction The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations. Materials and Methods This is a quality improvement pre–post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants’ self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard. Results A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = −11.29, p &lt; 0.001. A paired t-test revealed a significant increase in exam scores from pre (M = 70.22, SD = 9.43) to post (M = 87.78, SD = 7.19), t (17) = −7.31, p &lt; 0.001. There was no pre-intervention skills assessment, however, all participants (n = 18, 100%) passed the tourniquet application, needle chest compression, and insertion of nasopharyngeal airway. Conclusion TCCC for Army Aviators is easily implemented, demonstrates an increase in knowledge and confidence in providing prehospital care, and provides effective scenario-based training of necessary psychomotor skills needed to reduce preventable death on the battlefield. TCCC for Army Aviators effectively takes the TCCC for All Combatants curriculum and modifies it to address the unique considerations in treating wounded aviators and passengers, both in flight and after crashes. This project demonstrates on a small scale how TCCC can be tailored to specific military jobs in order to successfully meet the intent of the upcoming All Service Member TCCC course mandated in DoD 1322.24. Beyond Army aviation, this program is easily modifiable for aviators throughout the military and civilian sector.</description><subject>Armed forces</subject><subject>Casualties</subject><subject>Clinical Competence</subject><subject>Emergency medical care</subject><subject>Emergency Medical Services</subject><subject>General &amp; Internal Medicine</subject><subject>Helicopters</subject><subject>Hemorrhage - prevention &amp; control</subject><subject>Humans</subject><subject>Life Sciences &amp; Biomedicine</subject><subject>Medicine, General &amp; Internal</subject><subject>Military medicine</subject><subject>Military Medicine - education</subject><subject>Military Personnel</subject><subject>Pilots</subject><subject>Science &amp; Technology</subject><subject>Wounds and Injuries - therapy</subject><issn>0026-4075</issn><issn>1930-613X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqN0c9LwzAUB_AgipvTo1cpeBGkLmnSJjmOMn_AQA8TvJU0TaGjbWp-TOZfb0s3BS96ynvhw8vjGwAuEbxDkON5U9WNKubefhKOjsAUcQzDBOG3YzCFMEpCAmk8AWfWbiBEhDN0CiY4wohQFk_By1PT1apRrROu0m0g2iJYbkXtx1aXwVpIV0lRB6lucuGCVFgvarfrC6OCUptgYZpdsNhWwmljz8FJKWqrLvbnDLzeL9fpY7h6fnhKF6tQYo5dyCmNMSO8iChXPMnLnCtYCIkkLcsY5xFDrFACC04TVsRC9a2EnDIUJz2M8AzcjHM7o9-9si5rKitVXYtWaW-zqH8GEgIZ6en1L7rR3rT9dllEKGYRSsigwlFJo601qsw6UzXC7DIEsyHqbIw6G6Pu_dV-qs-H64M-ZNuD2xF8qFyXVlaqleqbQQjjhLOEk6EaNPu_Tqvxu1LtW_cThfbdH0t_ARzzqgc</recordid><startdate>20200814</startdate><enddate>20200814</enddate><creator>Scott, Stephen M</creator><creator>Carman, Margaret J</creator><creator>Zychowicz, Michael E</creator><creator>Shapiro, Mark L</creator><creator>True, Nicholas A</creator><general>Oxford University Press</general><general>Oxford Univ Press</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0400-0134</orcidid></search><sort><creationdate>20200814</creationdate><title>Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators</title><author>Scott, Stephen M ; Carman, Margaret J ; Zychowicz, Michael E ; Shapiro, Mark L ; True, Nicholas A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-97753849d279e96bfb9e0dac1c7ff53b2818dea3a9768d5ae18dc0978156e0d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Armed forces</topic><topic>Casualties</topic><topic>Clinical Competence</topic><topic>Emergency medical care</topic><topic>Emergency Medical Services</topic><topic>General &amp; Internal Medicine</topic><topic>Helicopters</topic><topic>Hemorrhage - prevention &amp; control</topic><topic>Humans</topic><topic>Life Sciences &amp; Biomedicine</topic><topic>Medicine, General &amp; Internal</topic><topic>Military medicine</topic><topic>Military Medicine - education</topic><topic>Military Personnel</topic><topic>Pilots</topic><topic>Science &amp; Technology</topic><topic>Wounds and Injuries - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scott, Stephen M</creatorcontrib><creatorcontrib>Carman, Margaret J</creatorcontrib><creatorcontrib>Zychowicz, Michael E</creatorcontrib><creatorcontrib>Shapiro, Mark L</creatorcontrib><creatorcontrib>True, Nicholas A</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Military medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scott, Stephen M</au><au>Carman, Margaret J</au><au>Zychowicz, Michael E</au><au>Shapiro, Mark L</au><au>True, Nicholas A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators</atitle><jtitle>Military medicine</jtitle><stitle>MIL MED</stitle><addtitle>Mil Med</addtitle><date>2020-08-14</date><risdate>2020</risdate><volume>185</volume><issue>7-8</issue><spage>e1271</spage><epage>e1276</epage><pages>e1271-e1276</pages><issn>0026-4075</issn><eissn>1930-613X</eissn><abstract>Abstract Introduction The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations. Materials and Methods This is a quality improvement pre–post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants’ self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard. Results A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = −11.29, p &lt; 0.001. A paired t-test revealed a significant increase in exam scores from pre (M = 70.22, SD = 9.43) to post (M = 87.78, SD = 7.19), t (17) = −7.31, p &lt; 0.001. There was no pre-intervention skills assessment, however, all participants (n = 18, 100%) passed the tourniquet application, needle chest compression, and insertion of nasopharyngeal airway. Conclusion TCCC for Army Aviators is easily implemented, demonstrates an increase in knowledge and confidence in providing prehospital care, and provides effective scenario-based training of necessary psychomotor skills needed to reduce preventable death on the battlefield. TCCC for Army Aviators effectively takes the TCCC for All Combatants curriculum and modifies it to address the unique considerations in treating wounded aviators and passengers, both in flight and after crashes. This project demonstrates on a small scale how TCCC can be tailored to specific military jobs in order to successfully meet the intent of the upcoming All Service Member TCCC course mandated in DoD 1322.24. Beyond Army aviation, this program is easily modifiable for aviators throughout the military and civilian sector.</abstract><cop>OXFORD</cop><pub>Oxford University Press</pub><pmid>32314785</pmid><doi>10.1093/milmed/usz491</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-0400-0134</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current)
subjects Armed forces
Casualties
Clinical Competence
Emergency medical care
Emergency Medical Services
General & Internal Medicine
Helicopters
Hemorrhage - prevention & control
Humans
Life Sciences & Biomedicine
Medicine, General & Internal
Military medicine
Military Medicine - education
Military Personnel
Pilots
Science & Technology
Wounds and Injuries - therapy
title Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators
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