A whole new level of realism

Reserve Citizen Airmen of the 944th Aeromedical Staging Squadron hosted training that tested personnel to their limits Jan. 8-10, 2021, at Luke Air Force Base, Ariz.

The 944th ASTS holds the distinction of being a National Association Emergency Medical Tactical Casualty Combat Care training site. The objective of TCCC is to use evidence-based practices to provide life saving measures and trauma management strategies in battlefield like conditions.

Staff Sgt. Sergio Tosi, 944th Aeromedical Staging Squadron medical technician and Senior Master Sgt. Jeffrey Neilsen, 944th ASTS medical material medic, prepare pork tracheas
Staff Sgt. Sergio Tosi, 944th Aeromedical Staging Squadron medical technician and Senior Master Sgt. Jeffrey Neilsen, 944th ASTS medical material medic, prepare pork tracheas to be used for advanced surgical airway training Jan. 7, 2021, during Tactical Casualty Combat Care training at Luke Air Force Base, Ariz. (Air Force photograph by Master Sgt. Louis Vega Jr.)

Having this distinction is unique for this unit because they are the longest upstanding certified TCCC training unit in the Air Force Reserve. They have been facilitating this training since 2012 and provide this course for all branches of service including civilian organizations.

“The Air Force is phasing out what we know as Self-Aid and Buddy Care and moving into TCCC,” said Capt. Breck Smith, Officer in Charge of Joint Medical Operations Training Initiative.

This transition comes after evaluating the needs of the military over the past several years.

“SABC is basic first aid and at the time that was ok, but TCCC is an adaption of what we are learning from war,” Smith said. “The easiest way to think of it is that TCCC means taking care of patients while getting shot at.”

When looking at patient care and deaths throughout the past few years, the Defense Health Agency came to the conclusion that almost 90 percent of all combat deaths occur before the casualty reaches a medical treatment facility.

Tim Freund, Buckeye Fire Department SWAT medic
Tim Freund, Buckeye Fire Department SWAT medic, talks with Luke Air Force Base Airmen Jan. 7, 2021, about needle decompression and occlusive dressing applications during Tactical Casualty Combat Care training at Luke Air Force Base, Ariz. (Air Force photograph by Master Sgt. Louis Vega Jr.)

“We learned that a large portion of those deaths were preventable,” said Smith. “The two biggest reasons were from hemorrhaging and airway obstruction.”

Smith explained that TCCC tackles the biggest threat to our service members, preventable deaths, making this training imperative to all of the military.

“During the 3-day course, participants learn the 3 phases of care: Care Under Fire, Tactical Field Care and Tactical Evacuation,” said Master Sgt. Lysa Busalacchi, 944th ASTS NAEMT site coordinator. “Students practice learned skills in static stations, where our goal is to emulate realism. This includes utilizing pork tracheas for advanced surgical airway training, chicken legs for simulated intraosseous infusions and racks of ribs to simulate needle decompression techniques.”

All of the students’ acquired knowledge is put to the test during a field exercise on the final day of training.

“TCCC means care under fire which means we conduct the training under fire,” Smith said. “As nurses, when we deploy, under the Geneva Convention we are non-combatants, but we still have to train on weapons because we have to protect our patients. Basically, defensive measures only.”

Capt. Scott Balak, Buckeye Fire Department SWAT medic, holds an intraosseous infusion needle
Capt. Scott Balak, Buckeye Fire Department SWAT medic, holds an intraosseous infusion needle Jan. 7, 2021, while 944th Fighter Wing Reserve Citizen Airmen observe during Tactical Casualty Combat Care training at Luke Air Force Base, Ariz. (Air Force photograph by Master Sgt. Louis Vega Jr.)

To make this as real as possible, ASTS reached out to the 944th Security Forces Squadron to acquire paintball guns to produce a live fire environment. To take it a step further Smith’s team coordinated with Techline Technologies Incorporated.

“Techline Technologies offers trauma simulation equipment to help in the training process of military, law enforcement, fire departments, and medical responders,” said Jay Hibberd, business development specialist and director of training.

Techline has a mobile training unit that goes out and teaches anything from life saving techniques to advanced courses like TCCC.

“We brought our TOMManikin to the training,” Hibberd said. “It is a breathing, bleeding, talking, articulating 185 pound manikin that we control through a tablet.”

Smith and Hibberd agreed that having these two elements available during the training is great exposure for the best patient care.

Capt. Scott Balak, Buckeye Fire Department SWAT medic
Capt. Scott Balak, Buckeye Fire Department SWAT medic, holds an intraosseous infusion needle Jan. 7, 2021, while 944th Fighter Wing Reserve Citizen Airmen observe during Tactical Casualty Combat Care training at Luke Air Force Base, Ariz. (Air Force photograph by Master Sgt. Louis Vega Jr.)

“It’s one thing to learn something on a PowerPoint,” Smith said. “It’s totally different performing your task on a manikin that is giving you direct feedback. When you perform the task correctly you can see the result first-hand, all while under fire.”

One nurse quickly understood the impact of the instinctive training.

“In most of our training we have been working with basic dummies with imaginary wounds and the most we do is talk through what we would do the fix the problem in a classroom,” said Staff Sgt. Catelynn Apple, 944th ASTS medical technician. “In this training we had the realistic dummies that were yelling, communicating, and bleeding. They only stopped bleeding when we did the proper care, so it was great hands-on because we can see what and if we are doing anything wrong.”

Throughout the scenarios the Airmen were tasked with providing security, conducting patient care, and moving out of a hostile environment with their patient. The nurses in the class struggled at first with maintaining their roles.

“Our mindset is to go straight to the patient to take care of them but we have to put in our minds to stop and evaluate the scene, then stabilize the patient enough to move them to a safer location,” Apple said.

Participants of a 944th Aeromedical Staging Squadron led Tactical Casualty Combat Care
Participants of a 944th Aeromedical Staging Squadron led Tactical Casualty Combat Care, TCCC, training assess a simulated patient’s injuries after removing him from a hostile environment at Luke Air Force Base, Ariz., Jan. 8, 2021. The Air Force is replacing Self Aid Buddy Care with TCCC in response to realizing that a large number of service member’s deaths could have been. (Air Force photograph by Tech. Sgt. Courtney Richardson)

To make it easier on herself, Apple refocused her mind on the purpose of security and how she was still helping the wounded even if it wasn’t hands on.

“Having to break the role from medic to security was a lot easier than I thought it would be because in my mind I am still taking care of the patient while I’m holding the weapon,” Apple said. “If I move I endanger everyone behind me who is providing direct patient care. Knowing when to switch and how to effectively do that was a great learning experience for me.”

Since the amount of TCCC approved locations are still being developed, the 944th ASTS has leaned into its partnerships with local law enforcement agencies allowing them to obtain certification as well. One Buckeye Special Weapons and Tactics member walked away from the training with unexpected and valuable new information.

Jim Clark, Buckeye Fire Department fire captain and SWAT medic, explained that he has received a lot of training over his 27 year career in his own respective battlefield so he thought he would be fully prepared to attend this course. Maneuvering around, securing the building, and providing patient care wasn’t the challenge, it was something he least expected.

“We typically focus a lot of the training on our respective battlefields but with the world changing, our battlefields are now across the United States,” Clark said. “This training was real-life, it re-enforced what I know and opened my eyes to something I lost value in; communication.”

Clark only knew two other people at this training, one being an instructor. This forced him see how lack of communication can hold back providing care.

“When I am with SWAT team, I know what they know,” Clark said. “I know their movements and hand signals, and they know mine. This training made me realize that if I found myself in a situation while off-duty, I might be rendering care with the aid of any other concerned citizen and I wouldn’t know how they think, so communication could save a life. Being in this class is perfect for me because I was able to work on my communication skills and help extract and treat patients.”

Participants of a 944th Aeromedical Staging Squadron led Tactical Casualty Combat Care
Participants of a 944th Aeromedical Staging Squadron led Tactical Casualty Combat Care, TCCC, training drag a simulated patient to safe location while still under fire at Luke Air Force Base, Ariz., Jan. 8, 2021. The training is being conducted in response to the Department of Defense noting that service members need more experience taking care of each other in the field, thus preventing the number of casualties. (Air Force photograph by Tech. Sgt. Courtney Richardson)

Clark explained that taking the course with the Airmen helped him realize that he needs to pay attention to his audience, understand everyone’s experience level, and how to communicate better to accomplish the task at hand.

Through it all Smith had one personal goal for the class.

“I hope to provide a whole new level of realism to the students so that when they go downrange or respond in any emergency situation, they don’t freeze,” Smith said. “They’ll know what that stress can feel like and the shock value is lessened. They can let muscle memory take over, making them capable of providing patient care as needed.”

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