r/TacticalMedicine • u/bleutheory Medic/Corpsman • Jul 13 '25
TCCC (Military) Ramblings from a drunk soldier to their NCOs
I want you to fail. When we train, push every scenario until it snaps. Kill the manikins cut the comms, drain the supplies. Listen for where we struggle, that is what shows you the weak spots. As medics we need to do better. Know what normal feels like: steady pulse, easy breath, warm skin. The second that changes, you should feel it in your gut. Trauma is improv and medics have to be the masters of it. Gear fails, supplies run out, but the enemies don't care. No tourniquet? Make one . No chest seal? Plastic and tape. No airway? Find one. The next fight will land on the kid fresh out of AIT, not us not the ones who are teaching it. What we do now decides if our friends make it home. Let them struggle so they learn to adapt. Let failure light up every crack and then show them how to fix it. Fail here, learn here, run it again. The people who rely on us aren't nameless characters they are people we have lived with we know them, they are the ones we have spent months if not years with. I went to their kids birthdays. Helpted set up parties for them. Chase better every time.
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u/little_did_he_kn0w Medic/Corpsman Jul 13 '25
God help you if you if CoTCCC hears you possibly imply that we should practice making tourniquets again. I mean, we definitletly should, but damn everyone gets a tight butthole about that one.
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u/XGX787 Jul 13 '25
I think everyone should know how to make an improvised tourniquets, but they should never have to do it.
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u/little_did_he_kn0w Medic/Corpsman Jul 13 '25
I agree. If we are at the point where we are having to make tourniquets out of cravats again, something has gone horrifically wrong. However- EVERY Medic/Corpsman should know how to do it.
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u/bleutheory Medic/Corpsman Jul 13 '25
Don't worry I don't hide my thoughts on that one and am very vocal about my opinions. Most courses are showing how to make improvised ones again. At least the predeployment ones. I know for a fact BCT3 and TCMC both show how to make an improvised one.
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u/Resident_Job3506 Jul 13 '25
My initial training in first aid, and the first day that I took down range in combat was all around improvised tourniquets. The training was quite literally take the Marines belt off and use a k bar as a windlass.
Fast forward a few decades and we have the spoke tourniquets that do a remarkable job. Israeli bandages as pressure dressings.
But those might not be there. Learn to improvise adapt and overcome.
Or learn to fail.
Your choice.
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u/little_did_he_kn0w Medic/Corpsman Jul 13 '25
I have terrible news for you- I haven't had a Marine in any unit I have been in who has had a Ka-Bar or a bayonet issued to them, and I've been in almost 15 years. Honestly, the lack of an easily accessable metal rod-like object might have something to do with why they do not want us making improvised TQs anymore.
That being said, the tone in my original comment was hard to read- I am for learning to improvise any of our adjuncts, as long as it is done correctly; CoTCCC be damned.
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u/Docrobert8425 Jul 13 '25
I think us old farts took all the Ka-Bars home! Still have the one I was first issued, they came off our armory's books back in 06 and good lord, I had to deal with "sharpening" accidents for the next 3 months like it was going out of fashion!
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u/little_did_he_kn0w Medic/Corpsman Jul 13 '25
Thank God those Ka-Bars could be used to make tourniquets
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u/NaiveNetwork5201 Jul 13 '25
I think the folks at the JTS and sit on the two separate COTCCC panels know the difficulties that we are facing on a macro level. The individual and teams need to know their micro concerns with the characteristics of their formations and command. Stress the system and compound the effects of it. The CTCs are places to do this but mastery is achieved before then in small circles before it goes to BN level. Time and space will not be on your side.
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u/SuperglotticMan Medic/Corpsman Jul 13 '25
Trauma isn’t improv…signed, someone who has treated hundreds of trauma patients.
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u/bleutheory Medic/Corpsman Jul 13 '25
It absolutely is, and if you have treated "hundreds," as you say, then you should understand this more than anyone. Every casualty is completely different. You can have three casualties with the exact same injury pattern each will have their own unique presentation. You are reacting as you uncover more information. Trauma isn't an algorithm, it isn't a check list. It is improv because you are reacting to how that specific casualty is presenting to you.
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u/Aviacks MD/PA/RN Jul 14 '25
That’s all of medicine in general. But at the end of the day the treatment is the same, you shouldn’t be making it up as you go along. You shouldn’t have every scenario planned out in your head before it happens so you’re ready and know what to do. What you’re saying is bordering on sounding like you aren’t sure what to do and it’s a big mystery. But there’s an objectively correct course of action in basically every scenario in terms of proper treatment, the biggest differences and more ambiguity comes down to treatment priority. But there’s treatment itself stays the same.
The unfortunate truth is there aren’t a lot of substitutes for many pieces of equipment in medicine. What are you improvising to replace an ETT or LMA or OPA or NPA? At BEST if manual positioning doesn’t work then they’re black tagged anyways. Otherwise as for things like improvising a chest seal.. well chest seals can go in the trash anyways and have basically zero data to support them.
Hemorrhagic shock is the end result for basically all of anyways. What injuries are you seeing that have wildly different presentations that require you to improvise a treatment that’s different?
I get the sentiment but I think the take away is putting the pressure on to simulate real life scenarios. There’s no replacement for being comfortable under pressure and getting actual hands on exposure. But you can try your best to get there with training to real life-ish conditions in the mean time.
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u/bleutheory Medic/Corpsman Jul 14 '25
I wish I could up vote this a million times! I don't want them to "just make it up" I want them to be prepared for when something changes. When teaching combat medics I think we need to shift from drilling and teaching a single item as the best intervention and focus on the pathophysiology, what needs to happen to stabilize the patient, then introduce the best option to treat it. For example, Medics coming from the school house think Combat Gauze is some magic cloth that just stops bleeding. They don't understand it just speeds up what the body is going to do anyway but it still needs constant pressure to work. Then you replace the combat gauze with only the compressed gauze in their aid bag they have no idea what to do. I probably could have worded things better. I'm not the best at expressing my thoughts.
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u/SuperglotticMan Medic/Corpsman Jul 14 '25
Trauma is literally taught as an algorithm not only per CoTCCC but also in trauma bays and resus bays in the United States.
Assessment findings don’t result in improv it results in you digging deeper into that finding and knowing what to do.
I’ve ran penetrating trauma, blunt trauma, multiple GSW patients at once, critical head injuries and none of those would I say my treatment was improvised. They were educated and logical decisions made in prehospital environments.
Ricky Rescue airsoft medic and Johnny the volunteer fireman do “improvised” medicine. Medics and Corpsmen do not. We have higher standards and our patients deserve as such.
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Jul 13 '25
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u/tolstoy425 Jul 13 '25
When was the last time many of us have seen combat in LSCO? Iraq? And how about against another military with greater personnel, manpower, logistics and leadership than Saddams army?
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u/bleutheory Medic/Corpsman Jul 13 '25
You are right. Hell the last time I was in Afghanistan was 17 since then I haven't been out of the country. The last generation that even comes close to fighting an equal enemy are the Vietnam vets. Desert storm and even the invasion of Iraq aren't really a good comparison to what we should expect. To be honest I don't even think that three war in Ukraine will he similar to what we should expect. But who knows. My post was initially about just the way we teach our new medics and my frustrations with not letting people fail during training. I completely understand that the way I look at things is not always the way others do and don't expect anything different. I love hearing other people's perspective.
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u/bleutheory Medic/Corpsman Jul 13 '25
This is probably just a post to make people angry. But You are absolutely right. A lot of people haven't. There are people right now teaching the new generation that have never even seen an actual patient. We have experienced medics who have no interest in making a difference and would rather talk down to the next generation. So what ideas do you have to help fix that?
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u/Porchmuse Jul 15 '25
Never a medical guy, actually a pre 9/11 guy. When training always throw in variables.
“This guys dead—you’re in charge”
“Nope, plan has changed”
“Hey—enjoy some CS grenades”
Etc.
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u/tolstoy425 Jul 13 '25
I agree with you on cutting comms and taking away supplies. I believe we should stop making notional aspects of training like supplies, comms, evac, etc. And I think if we’re gonna get real about training for the next fight we need to get away from notions that your patient dying = you failed. Medics are gonna be overwhelmed, medics are gonna be undersupplied.
What are you gonna do when you need to draw FWB and the BC is like “Uh fuck no man I can’t have you drawing blood rn I need my shooters up there.” Train reverse triage, overwhelm trainees with too many casualties that they couldn’t possibly care for. Prepare trainees to make decisions on who lives and dies (and I’m not talking about in the context of the traditional triage system).