Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Abstract

ObjectivesThe Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.MethodsMEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.ResultsNinety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).ConclusionsThe evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.Level of evidenceSystematic review, level III.

Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare

“…An inflation of a cuff with cold air will cause high cuff pressures with risk of rupture because the inflated air will warm and expand and cold tubes may cause FCI at the point of contact [ 18 , 21 ]. Freezing of condensation water may cause equipment dysfunction and tube/heat moisture filter obstruction [ 22 , 35 ]. If the patient is not in respiratory distress, a cold air mask or, if not available, a scarf should be placed over the external airway, to better pre-warm the inhaled air.…”

External Hemorrhage Control Techniques for Human Space Exploration: Lessons from the Battlefield

“…[61][62][63] Nevertheless, conclusive evidence remains weak. 24,64 In terms of safety, tourniquets have remained a controversial topic because of their complications, which are primarily related to ischemia and compression. 65,66 Reviews of recent combat and civilian experiences have shown minimal morbidity, but the total tourniquet time in these studies was less than 2 h in most of the casualties.…”

“…11 Both XStat and iTClamp may be particularly useful in space as they are small and require minimal training to us, but for both devices, efficacy and safety in prehospital and austere environments—including space—remain to be determined. 64…”