Military Providers, TCCC Certification, and the Use of Surgical Cricothyroidotomy

Research Paper Title

Prehospital Battlefield Casualty Intervention Decision Cognitive Study.


Airway compromise is the third most common cause of preventable battlefield death.

Surgical cricothyroidotomy (SC) is recommended by Tactical Combat Casualty Care (TCCC) guidelines when basic airway manoeuvres fail.

This is a descriptive analysis of the decision-making process of prehospital emergency providers to perform certain airway interventions.


The reserchers conducted a scenario-based survey using two sequential video clips of an explosive injury event.

The answers were used to conduct descriptive analyses and multivariable logistic regression models to estimate the association between the choice of intervention and training factors.


There were 254 respondents in the survey, 176 (69%) of them were civilians and 78 (31%) were military personnel.

Military providers were more likely to complete TCCC certification (odds ratio [OR]: 13.1; confidence interval [CI]: 6.4-26.6; P-value < 0.001). The SC was the most frequently chosen intervention after each clip (29.92% and 22.10%, respectively).

TCCC-certified providers were more likely to choose SC after viewing the two clips (OR: 1.9; CI: 1.2-3.2; P-value: 0.009), even after controlling for relevant factors (OR: 2.3; CI: 1.1-4.8; P-value: 0.033).


Military providers had a greater propensity to be certified in TCCC, which was found to increase their likelihood to choose the SC in early prehospital emergency airway management.


Schweizer, M.A., Wampler, D., Lu, K., Oh, A.S., Rahm, S.J., Studer, N.M. & Cunningham, C.W. (2020) Prehospital Battlefield Casualty Intervention Decision Cognitive Study. Military Medicine. 185(Suppl 1), pp.274-278. doi: 10.1093/milmed/usz226.


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