title: An evaluation of tactical combat casualty care interventions in a combat environment.
abstract: BACKGROUND
  Tactical combat casualty care (TCCC) is a system of prehospital trauma care designed for the combat environment. Although widely adopted, very few studies have reported on how TCCC interventions are actually delivered on the battlefield, from a quality of care perspective.
  
  
  METHODS
  This was a prospective study of all trauma patients treated at the Role 3 multinational medical unit (MMU) at Kandahar Airfield Base from February 7, 2006 to May 30, 2006. Primary outcomes were whether or not two TCCC interventions were underused, overused, or misused. Interventions studied were needle decompression of tension pneumothoraces and tourniquet application for exsanguinating extremity injuries.
  
  
  RESULTS
  One hundred thirty-four trauma patients were treated at the Role 3 MMU during the study period. Six patients had eight tourniquets applied. Five tourniquets were applied to four patients appropriately and saved their lives. There was one case of misuse where a venous tourniquet was applied. There was one case of overuse where one patient had two tourniquets placed for 4 hours on extremities with no vascular injury. There were seven cases where needle decompression was underused: seven patients presented with vital signs absent with no needle decompression. There was one case of overuse of needle decompression. There were seven cases of misuse where the patients were decompressed too medially.
  
  
  CONCLUSIONS
  Tourniquets save lives. Needle decompression can save lives, but is usually performed in patients with multiple critical injuries. TCCC instructors must reinforce proper techniques and indications for each procedure to ensure that the quality of care provided to injured soldiers on the battlefield remains high.
authors.affiliation: Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. homer.tien@sunnybrook.ca
authors.forename: Homer C
authors.initials: HC
authors.lastname: Tien
authors.forename: Vincent
authors.initials: V
authors.lastname: Jung
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Acharya
authors.forename: John C
authors.initials: JC
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D019299:Decompression, Surgical / Q000592:standards* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards*; D005121:Extremities / Q000293:injuries*; D005260:Female; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008887:Military Medicine / Q000592:standards*; D009339:Needles; D011030:Pneumothorax / Q000601:surgery*; D011785:Quality Assurance, Health Care / Q000592:standards; D014111:Tourniquets / Q000592:standards* / Q000706:statistics & numerical data; D019564:Unnecessary Procedures; D014600:Utilization Review; D014857:Warfare; D014947:Wounds and Injuries / Q000601:surgery*