I've taken some time tonight to review a few pages of the TCCC discussion, and I thought I would weigh in. I was unaware of this site until one of my friends e-mailed me about it today. Otherwise, I would have been here sooner.
First, let me say that I was the Course Director for the 1 CMBG pilot course that was held in July '03, so the comments I make are from first hand experience.
Second, I am delighted that there has been a lot of seemingly excited discussion here regarding TCCC. That is exactly what I had hoped to achieve when we started course planning over three years ago.
Third, I am again pleased that the dispatches article that Chris Kopp wrote and I edited seems to have made its way around for general reading.
Overall, I am confident the use of TCCC principles will eventually find their neiche. However, even after a lot of experience with the first pilot course, and moderate contact with the two subsequent courses within 1 CMBG, I can tell you that the optimal implementation of TCCC within the CF is going to be very difficult to sort out. The reason is that it is a combined medical and tactical course. Much of the discussion you folks have had has centred on who should be teaching the course, who should be trained, what the medical SOP's are and how TCCC should be integrated into them, optimal course duration, and the list goes on. We had similar questions when we did the pilot and the solutions are not easy to come by.
The issue of medical SOP's is an interesting one. First, let me say that the entire structure of medical SOP's are from the WWII / Korea era. They simply do not work in the 360 degree threat environment that our soldiers face on many deployments. Nor do they work with the ever more common scenario of small party tasks that occur on deployments like Afghanistan. The medical branch simply does not have enough medics to go around to support all the activities that occur during an operation like we did in Kandahar or like is occurring in Kabul. Recognizing the new ways the army was being employed was paramount in pushing for a new way to support the soldiers on the pointy end, and short of hiring and training enough medics so that you had one for every section of soldiers, the TCCC approach seemed a logical and necessary alternative. Secondly, the St. John Amb FA course is woefully inadequate for the needs of today's soldiers. I'm not telling you all anything you don't already know.
So,..... who should teach the course? In my opinion, the course should lay the foundation for cooperation between the combat arms and their medical support. This course is best implemented with the medical reps maintaining overwatch of the quality control ref medical aspects. The tactical aspects need to be spearheaded by a rep of the audience you are teaching i.e. teaching tankers... you need someone who can help to insert the medical scenario into a realistic tactical scenario. The same is true when teaching infanteers, engineers, etc. So in many ways, each course should be different. This is going to be difficult for the CF because of the layers of coordination and cooperation this involves. On our pilot I was course director and an infantry officer served as course officer, and it worked well because he knew he drove the scenarios, I just supplied the medical input and oversight. If we make this just a course about providing soldiers with intermediate medical skills, we've missed the boat entirely. And I'll go one better,..... TCCC should be an integral part of every field exercise, large or small. You can practice your infantry or engineer skills all you want, but when someone gets hit, you better know how to react or chaos ensues. The experience of many militaries has shown us that.
I'm preaching here a little but I'll continue. Should medics be required to take TCCC? Absolutely. Anyone who thinks medics only work at the CCP, UMS, Fd Amb levels hasn't been on a deployment in a while. In fact I would argue that the school in Borden should have a battle school component (which suprisingly they do not). So they may have decent medical skills but haven't once been asked to deliver those skills under realistic combat conditions Soldier first, medic second. Fire superiority is the best medicine. Keep yourself from getting shot!! Need I say more. And furthermore, I think every medic going to a UMS with a front line combat arms unit should first have to have a TCCC course as a prerequisite. I think the ratio of TCCC trained soldiers to non trained should probably be 1:10. Pretty high expectations, huh? Again, train how you fight so you will fight how you were trained. If we deliver this training in the all too common abbreviated, just in time, typically canadian format prior to a mission, we're already behind the 8 ball.
How long should the course be? There are some significant interventions taught in TCCC. Too short a course risks producing grads who are simply dangerous. Too long if fiscially unacheivable. IF TCCC was integrated into the regular training routine, a TCCC course could be done in 7-10 training days with the right staff. Again, it is essential that there be an FTX component. Otherwise, we are simply teaching a medical course. The tactical component is just as important, if not more important to producing competent grads.
Resource issues. They're numerous and I'm not even going to go there.
Mentality. The biggest obstacle we face in making TCCC a success or just another painful course that you need to go on is the way in which it is delivered..... not simply the course content. I always get very concerned when I hear people say, "I read about the components of the course, it's not that complicated". They're right, the content is relatively straightforward medically. The crux of the issue is developing a dynamic and realistic course that mimics the operational environment.
I could go on, but I'm sure some of you are tired of my philosophizing. Sufficie it to say that I have concerns over the ability of the medical branch to ensure a quality product is delivered. It is one of the many reasons I released in 2003.
When we started the TCCC initiative in 1 CMBG our ultimate goal was to get the info out to the front line soldiers. In large part, I think that's happening. My concern now is whether or not all of the issues above, and more, will be overcome. My reasons for posting this e-mail are mainly to encourage you all to look closely at the end product and demand that it meet the need. Anything else is just glorified advanced first aid.
Dr. Roger King
Ex-MO now a civi
