New AF TCCET Teams and Mission Creep Defined.

amlove21

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So, I want to get a different view here. Maybe I am just being a little butthurt. After reading the below article, someone please explain to me why this asset is 1- needed and 2- NOT a less capable Pararescue team?

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New tactical care teams aim to save more lives



By Markeshia Ricks - Staff writer
Posted : Saturday Jun 2, 2012 10:00:02 EDT

The U.S. military is enjoying the highest casualty survival rate in the history of modern warfare, but medical officials believe they can save even more lives by getting advanced care sooner to injured troops.
For nearly a year, a three-member team of Air Force health professionals has successfully evacuated and treated 299 severely wounded troops by taking the emergency department to the injured, and another team is set to stand up in the coming month.
Known as tactical critical care evacuation teams, or TCCET, the teams comprise an emergency medicine or critical care physician, a certified nurse anesthetist and an emergency department nurse or intensive care/critical care nurse. The teams specialize in moving and treating patients who have just been injured and risk dying if emergency treatment isn’t administered immediately.
The first team’s skills are being put to good use quickly as troops continue the fight in Afghanistan, where the improvised explosive device remains the enemy weapon of choice.
Many of the casualties of Operation Enduring Freedom suffer blast-related injuries such as burns, lung trauma, traumatic amputation, blunt force trauma and head injuries, according to Air Mobility Command surgeon Brig. Gen. (Dr.) Bart Iddins.
AMC is the lead agency for military aeromedical evacuation around the world, and missions are typically flown by air mobility aircrews and medical teams on C-17, KC-135, or C-130 aircraft. More than 186,000 patient movements have been successfully completed since the onset of operations Iraqi Freedom, New Dawn and Enduring Freedom.
Though every combat medic and many nonmedical combatants are trained to deliver tactical combat casualty care on the battlefield, Iddins said the injuries sometimes are so severe that they exceed those capabilities.
Tactical combat casualty care has saved many lives, but is in no way definitive treatment, Iddins said. “The casualty must still be evacuated to a higher level of medical care.”
BRIDGING THE GAP

Finding a way to provide more advanced care at the point of injury will provide a missing piece of the complex puzzle that is war-related trauma treatment. A study published last year in The Journal of Trauma found that 51.4 percent of “battle injury, died of wounds” deaths were “potentially survivable” injuries. Military medical officials believe tactical critical care evacuation teams can help turn that statistic around.
When it comes to treating and evacuating casualties with life-threatening injuries, the military has several options for treatment and evacuation, including its 119 critical care air transport teams, or CCATTs, of which 12 are deployed at any given time to support the war effort, according to Iddins.
Like the tactical teams, CCATTs comprise a three-member team of health professionals that include a critical care doctor, nurse and respiratory technician, but are mostly equipped for maintaining a stable patient during evacuation out of theater on a fixed wing aircraft, Iddins said.
The new tactical teams, which will fly most movement missions on rotary wing aircraft such as a Black Hawk helicopter, are equipped and trained to start trauma resuscitation treatment immediately after injury. And they’re able to do that work in the tight confines of a helicopter with very little equipment.
Iddins said the most common cause of preventable death on the battlefield is uncontrolled bleeding, loss of airway and tension pneumothorax in the lungs. Unlike those trained in first-responder care or combat care, TCCETs are trained and equipped specifically for dealing with such emergency scenarios, Iddins said.
The tactical team is capable of performing aggressive damage control resuscitation such as airway management, mechanical ventilation, blood administration/low-volume resuscitation, hemorrhage control, coagulopathy (bleeding) management, invasive monitoring, vasoactive (increase blood pressure) medication administration and other interventions as required throughout the course of an evacuation, according to Iddins.
That kind of aggressive treatment saves lives, Iddins said, but is beyond the scope of traditional pre-hospital tactical casualty evacuation capabilities. “TCCET is designed to bring a higher level of medical care directly to the casualty, specifically at the point of injury, in order to initiate emergency department/trauma department-level control resuscitation earlier and more aggressively than has traditionally occurred.”
WORK AMID UNIQUE ENVIRONMENT

Maj. Michael McCarthy, deputy director at the Center for the Sustainment of Trauma and Readiness Skills in Cincinnati, said that though members of the new tactical teams can conduct a CCATT mission, the teams are specifically trained to deliver high-level, critical care in the tight spaces of a helicopter with limited supplies. Unlike CCATT members, tactical care team members also are trained in combat survival.
During their 10 weeks of training, McCarthy said, future team members will spend time in a simulator that mimics conditions in Afghanistan based on experience gleaned from the first team.
“You’re space-restricted, you’re in a dark environment where you have to use low light and capability,” McCarthy said. “We pipe sound in that’s about 90 decibels … and we make them do whatever the simulation or objective is.”
McCarthy said all the training is meant to help airmen adjust to the austere environment they’ll be working in and help them identify when they’re overwhelmed.
“The [task saturation] threshold is different for every person, but what we focus on here is that you be able to recognize that you’re getting task-saturated, take a step back, call a timeout and redirect your team,” he said.
McCarthy said this mission is unique to the military and the Air Force, though civilian air care programs have provided critical transport for years.
“They don’t bring the same capability that we do, they don’t do it in same austere environment,” McCarthy said. “They don’t have the same team component, and they definitely don’t function in a combat zone.”
READY TO EXPAND

The success of the first TCCET operating downrange has service officials champing at the bit to get the second team into action.
AMC plans to stand up the next team by the end of May or early June, Iddins said. The command also is expanding the number of personnel for sustaining current and future mission requirements.
Whether there will be more than two teams remains to be seen, but signs are good. Tactical teams are currently sourced from active-duty and Air National Guard components, but there are plans to put Air Force Reserve members in the mix as full teams or as individual augmentees, Iddins said. Team deployments are 179-day rotations.
“The TCCET casualty movements have been enormously successful — there have been no reported deaths, nor complications associated with TCCET movements thus far,” Iddins said.
 

0699

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Everything is better if you use the word tactical. I'm surprised they didn't use the word operator too (tactical care operator), as that would have improved their efficiency and capabilities 100%. Give them their own beret and they could be the newest Tier 1 guys...

:rolleyes:
 

AWP

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Maj. Michael McCarthy, deputy director at the Center for the Sustainment of Trauma and Readiness Skills in Cincinnati, said that though members of the new tactical teams can conduct a CCATT mission, the teams are specifically trained to deliver high-level, critical care in the tight spaces of a helicopter with limited supplies. Unlike CCATT members, tactical care team members also are trained in combat survival.
During their 10 weeks of training, McCarthy said, future team members will spend time in a simulator that mimics conditions in Afghanistan based on experience gleaned from the first team.
“You’re space-restricted, you’re in a dark environment where you have to use low light and capability,” McCarthy said. “We pipe sound in that’s about 90 decibels … and we make them do whatever the simulation or objective is.”

HOLY SHITBALLS!!!!!!!!!!!!!!!!!!! Trained to operate in the tight spaces of a helicopter? 10 whole weeks of school to do this in sounds up to 90 decibels? And in the dark where the boogeyman lives?

Drain the pool at Lackland, kill the 1T2X1 AFSC, and just add 10 weeks of school on top of a military nurse or doc's pipeline and you're all set.

easy-button.jpg


PS: Send a case of Tuck's pads to all of the IDMTs that just had their mission stolen from them....the mission they tried to steal from Pararescue a few years ago, and tell them the circle is complete.
 

DA SWO

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My take is non- 1st responder.
i.e PJ/Dustoff does the pickup initial transport, and the CCAT/TCCAT does the next move.
What isn't said is the helo they are using? CH-47?
This could actually be fun to watch as the CSAR-X could end up being a HH-47.
Why is AMC doing tactical anything besides airlift?
 

policemedic

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This may hurt some people's feelings, so I'll be unusually kind and preface my opinion by saying that I am absolutely a strong advocate of improving care at the point of wounding and throughout the entire continuum of hospital/rehab treatment.

With that said, BG Iddins is at best simply disingenuous and at worst colossally ignorant of the capabilities of conventional and SOF medics. MAJ McCarthy is likewise suffering from craniorectal inversion.

.
The tactical team is capable of performing aggressive damage control resuscitation such as airway management, mechanical ventilation, blood administration/low-volume resuscitation, hemorrhage control, coagulopathy (bleeding) management, invasive monitoring, vasoactive (increase blood pressure) medication administration and other interventions as required throughout the course of an evacuation, according to Iddins.


There is a name for this kind of care provider; in fact, there are several. Paramedic, PJ, SF Medical Sergeant, Independent Duty Corpsman...All of whom are equipped with the skills to perform everything above. They are notably different from the TCCET team in their more highly developed gunfighting and tactical skill sets.


I am not making an argument that a medic can manage a trauma resuscitation as well as a physician. I do believe that it is abundantly clear that in the combat setting, at the point of wounding and in transportation to a CSH, there is no difference in functional capability between a well-trained paramedic, 18D, PJ, etc., and a physician. The limitations of working in an austere, resource constrained environment mitigate the physician's superior knowledge base and procedural skill.

That kind of aggressive treatment saves lives, Iddins said, but is beyond the scope of traditional pre-hospital tactical casualty evacuation capabilities. “TCCET is designed to bring a higher level of medical care directly to the casualty, specifically at the point of injury, in order to initiate emergency department/trauma department-level control resuscitation earlier and more aggressively than has traditionally occurred.”


Bullshit. Even our basic, fresh from the schoolhouse medics do a fine job at rapidly treating the three main causes of preventable death on the battlefield. To argue otherwise is to highlight one's own bias and demonstrate stellar idiocy.

there have been no reported deaths, nor complications associated with TCCET movements thus far,” Iddins said.

This just means they haven't seen enough very sick patients. The fact that Iddins made that statement is prima facie proof that he's too dumb to draw breath.
 

Salt USMC

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This sounds a lot like the British MEDEVAC team they've got out here in country these days. Supposed to be a flying hospital in the back of a 47. For the life of me I cant remember the name of it, though.
 

amlove21

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My POV: do it! Let them have it. For once in the air forces big blue gay life, let the PJs go where they need to go (ie farming out to other SOF teams as imbedded CSAR. That's just me.
Quote of the thread. This article pisses me off in so many ways, it's unreal. However, if they did take the FOB-FOB transfer mission (which is why they claim 290 missions and no deaths, fucking liars), and left us with only hot LZ POI pickups- then shit, we'd actually have the manning to support the missions that need us. What a novel concept.
 

Ranger Psych

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Going further, this sounds like Medevac on steroids.... which is something I've heard that PJ's don't do, you don't do casevac or medevac, you do personnel and equipment recovery. So, if anything, this would "hopefully" be what would be showing up when you have conducted said recovery and now it's time for extraction of said injured and recovered personnel.

Let's think about this for a minute. Policemedic cited a bunch of duty positions that are capable of a large majority of the tasks due to extensive training. Let's face it, we pass off patients to higher level care. Being completely honest, PJ's, Ranger medics, SF medics shouldn't be passing their patients off to (as an example) your run-of-the-mill medevac. Unless things have changed drastically from when my wife was working on enlisting, Paramedic qualification is a SSG/E-6+ thing that happens for leg medics.

I know that when I did some training with the Medivac units on Benning many moons ago, as an EMT-B with additional instructor credentials and classes under my belt... AS INFANTRY, I was effectively higher qualified than they were. Toss on what additional stuff I got OJT'ed on and what I would have on my medsov or load onto a casevac platform? I was rolling better trained and better equipped than your standard medivac platform and crew. Couple that with the expanded scope that all SOF medics have to varying degrees depending on duty, and you can run into passing off a patient to a crew that honestly isn't qualified, trained, or has a fucking clue as to how to handle.

We've all seen the flying er's. Now they're just flying on rotary wing instead and the ER comes to you. I think it's a good thing and it doesn't encroach on anyone's jobs, if anything it pushes the more tactically trained medical personnel that would be flying forward to where they could do more good, being a rifle on the ground until it's necessary to intervene immediately following the point of injury

And if their bird gets lit up? Honestly, you aren't in any worse of a position than you would be otherwise. Best case, you've got surviving medical personnel on the ground to try to keep who's left alive longer, worst case you've got about the same number of bags you have to deal with and extract. They obviously aren't going to have the same amount of tactical training nor recurring tactical training as "insert SOF medic type here" but that can be said for any medivac platform unless it's a SOF platform.
 

AWP

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Considering the AF's history with Pararescue this just sounds like an attempt for Big Blue to say "Our caregivers can do the PJ's mission, so why do we have so many J's?" The way the article is written it reads like AMC is trying to get a slice of the pie enjoyed by ACC. AMC's role is to take the patient from places like Bagram to Landsthul....now AMC is in the "tactical" business as well?

As an outsider it sounds like Big Blue is chipping away at Pararescue's mssion. In general I'm leery of any organization that does something on their own like this because mission creep is inevitable and 5-10 years down the road it becomes a case of "Why do we have two units doing the same mission?". I've personally witnessed it in Afghanistan, with the Air Force, but on communication systems and the infighting was brutal...now they are adding a MAJCOM to the mix with a high-profile mission?

I read it as a land grab.
 

JustAnotherJ

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I'll add my enlisted scum outlook again. If they want that mission so that PJs can perform the mission that we were intended to do, then I'm all for it. It could be a land-grab move, but the war is slowing down and hopefully transitioning to a SOF-led war, so the land that their grabbing is like a oil field on the verge of drying up. I don't mean to bash this new concept by any means because it's akin to shitting in our own house. I have faith that the PJ CFM and top level CRO's will get us into the right(ful) mission set and doing what we were truly bred to do. Though the casevac mission has created some real rock star PJs in medicine, I feel that it's time to evolve yet again, to meet the needs of the war to come. If it is taken over, the upper echelon will soon realize that PJs doing casevac have made uncommon valor, common. I think that will be the biggest shock to the system will occur when they no longer have teams hoisting into active fire fights or mine fields and assaulting their way to survivors.

Lastly and most importantly, 10 weeks of training will not mimic the capabilities of PJs...I say that not based upon ego, whatsoever, but more as a warning. Our pipeline is 1.5 years plus ~6 months of upgrade training just to produce a "combat ready" PJ, and even after that, a lot falls upon the Team Leader's shoulders to ensure true combat effectiveness. Placing highly trained medical professionals into a combat situation, IMO, is like utilizing Labrador's as IED/Hit dogs...the shock of combat is far greater upon them, versus a Malinois/German Sheppard; Two different animals that, though they are highly trained and good at what they do, do not necessarily place them into the same realm or level the playing field.

My fingers are crossed that this goes as I hope it does because if it doesn't, it's going to be really rough.
 

JustAnotherJ

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This sounds a lot like the British MEDEVAC team they've got out here in country these days. Supposed to be a flying hospital in the back of a 47. For the life of me I cant remember the name of it, though.
MERT - Medical Emergency Response Team

They're composed very similar to that of this proposed TCCET.
 

Salt USMC

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MERT - Medical Emergency Response Team

They're composed very similar to that of this proposed TCCET.

Thanks JAJ. I've not heard much about that particular element, but people say they're good for what they do, although they take a bit longer to spool up versus Dustoff/Pedro.
 

policemedic

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The comment about invasive monitoring goes further up my ass the more I think about it. Some AF doc is going to insert a Swan-Ganz as the bird lifts off the battlefield so he can look at a PCWP waveform? Good luck analyzing that inflight. Not to mention that this would be the worst possible time to try to insert any sort of invasive hemodynamic monitoring catheter.

The CCATTs do good work. In an inter-facility setting, critical care docs, anesthesiologists, nurses and medics can function as a highly capable multidisciplinary team.

This TCCET? I'm not sold.
 

JohnnyBoyUSMC

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So a question for those PJ's on here: what would be your preference were you to be suddenly promoted to the top of the AFSOC chain? How would you want the allocation of PJ's and their mission focus/training to go in light of units like this being stood up, the winding down of theaters of the GWOT, etc? I've seen a few things on here as to a general idea of what you'd like but wanted to hear some specific stuff you guys had in mind.
 

HealwithSteel1

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Going further, this sounds like Medevac on steroids.... which is something I've heard that PJ's don't do, you don't do casevac or medevac, you do personnel and equipment recovery. So, if anything, this would "hopefully" be what would be showing up when you have conducted said recovery and now it's time for extraction of said injured and recovered personnel.

Healwith Steel1 States:
This has been an interesting discussion on this topic. SOWT’s take is right that TCCET is a Non-1st Responder. Having some knowledge of the training of these TCCETs, I would point out the following facts:
1) TCCET does not train nor is it ever tasked to extract or treat casualties under fire. That is the PJ/ATP/combat medic mission.
2) The TCCET does train and is tasked to manage selected (read seriously injured) casualties when delivered to them by PJ/ATP/combat medics.
2) The TCCET provides critical care augmentation to a conventional MEDEVAC crew (68W/EMT-B) for seriously injured casualties so PJs/combat medics/ATPs can handoff to higher (not lower) level of care.
3) TCCET allows the PJ to get back to the fight faster where the GAWS capability is best utilized.
4) “Tactical” is to differentiate from the CCATT which does strategic evacuation. No berets are in the TCCET’s future.
 
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