An Observational Study of Combat Medics' Tactical Combat Casualty Care Medication Administration Through a Single-Center Simulated Trauma.

Abstract

Introduction: Timely battlefield resuscitation improves service member survivability. The Tactical Combat Casualty Care (TCCC) guidelines focus on early interventions to mitigate preventable causes of death. Key to this guideline is the early and correct administration of medications like tranexamic acid (TXA), antibiotics, analgesia, and calcium if indicated. A concerning trend in recent retrospective data reviews has found that combat medics have poor adherence to the TCCC guidelines, specifically inadequate tourniquet placement and underuse of TXA and analgesic medications. It is unknown what role knowledge and training play compared to complex operational factors. This is the first study to assess TCCC medication knowledge and drug administration for commonly used TCCC medications (TXA, calcium, ketamine, and ertapenem) in a simulated trauma training.

Materials and methods: This is a multiple-group cross-sectional observational study of simulated medication administration in accordance with TCCC guidelines. A convenience sample of medics, previously trained in TCCC, completed an individual simulated training that required the administration of 4 commonly used TCCC medications, TXA, calcium, ketamine, and ertapenem. Participant demographic and training data were collected. Trained graders assessed specific skills using a point-based checklist. This study was deemed exempt by the Institutional Review Board.

Results: There were 127 medics who participated, completing 432 unique medication encounters. Individual medications were correctly identified 85% of the time. The appropriate dose was identified 61% of the time. Individual medications were correctly administered 40.7% (95% CI, 34.7-43.1) of the time. Only 7% of participants identified, dosed, and administered all 4 medications correctly. Senior medics had higher rates of drug identification (1.084, 1.006-1.167). There was a trend toward higher rates of dose identification, but it was not significant (1.131, 0.963-1.327). For junior medics, dose identification was positively associated with Table VIII training within 6 months (1.414, 1.119-1.744) and self-perceived TCCC confidence (1.977, 1.271-3.387).

Conclusions: Significant deficiencies were noted in combat medics' administration of TCCC medications, suggesting that gaps in TCCC knowledge and skills may impact TCCC adherence in the operational environment. Further studies are needed to assess the efficacy of current training, the rate of skills atrophy, and interval training needs.