TCCC Standardization: The Time Is Now.

Trauma remains the leading cause of death in adults worldwide,1 and a significant portion of those deaths occur within the first 6 to 24 hours after initial injury secondary to hemorrhage.2,3 The evolution of modern-day trauma care has witnessed revolutionary changes over the past century, with lessons learned from war providing the primary stimulus. Major advances in surgical vascular procedures and resuscitation techniques, such as whole blood infusion, prehospital hemorrhage control, and a resurgence of immediate and aggressive tourniquet use, are more recent developments.4,5 In addition to prehospital advances, the timing from injury to medical interventions also emerged as an important factor for positive outcomes. During the wars in Iraq and Afghanistan, under the Tactical Combat Casualty Care (TCCC) construct, trauma care and the enhanced capability to collect trauma information from the battlefield have resulted in a greater understanding of managing penetrating injuries, explosive injuries, and life-threatening hemorrhage. The fatality rate during Vietnam was approximately 14%; that has dropped to 9% during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF).6 This improved survivability is widely attributed to two recent advances: rapid evacuation from the battlefield and early prehospital treatment. The purpose of our commentary is to emphasize that while great strides in prehospital care TCCC have been made in the past 14 years, the lack of institutional standardization is one of the remaining challenges of trauma care.