Table of Contents
Navy SEALS (Photo by Greg Mathieson/Mai/Getty Images)
The Presidential Civilian Medal, the second highest civilian award of our government, was established to recognize American citizens who have performed “exemplary acts of service to our nation.” Past recipients include Hank Aaron, Muhammed Ali, Bob Dole, Robert Gates and Colin Powell. On January 2, President Biden joined Navy Captain (retired) Dr. Frank Butler and 19 others to this list.
The White House The announcement explained his choice: “As a pioneering innovator, Navy SEAL, and leader in the field of diving medicine, Dr. Frank Butler Tactical Combat Casualty Care in the medical field, which set new standards for the use of tourniquets, not only for wartime injuries, but for everyday injuries as well. civil life. He transformed battlefield trauma care for the U.S. military and saved countless lives.”
The career path of Dr. Butler was unusual, even by the standards of military medicine. Before becoming a doctor, Butler was a Navy SEAL platoon commander. Butler’s first medical assignment was with the Navy’s Experimental Diving Unit, where he tested equipment and helped design diving protocols used by navies and special operations forces around the world.
After completing a Navy residency in ophthalmology and practicing for a few years, he returned to the Special Operations community as the biomedical research director for the Naval Special Warfare Command, overseeing and ensuring personnel health during training that all SEALs were fit for any mission. In the early 1990s, he became interested in improving battlefield trauma care.
The challenge of transforming healthcare on the battlefield
Most combat deaths die immediately or succumb to their wounds before reaching a medical facility. As they were all thought to be beyond saving, they were classified as ‘killed in action’ (KIA). As a result, battlefield treatment changed little for 130 years.
Dr. Butler knew better. He believed that improving battlefield care could increase survival rates. To put this idea into action, he and like-minded colleagues devised guidelines to address rapid bleeding, respiratory problems and other immediate life threats. They called the strategy “Tactical combat casualty care” (TCCC). Despite the logic of this approach, they encountered persistent resistance to changing long-standing policies.
Navy CAPT (Dr.) Frank Butler during his time as USSOCOM Command Surgeon – circa 2004
When (then) Captain Butler was appointed U.S. Special Operations Command surgeon in 2004, he saw an opportunity to challenge long-held assumptions about KIAs. He asked two trauma surgeons – Col. John Holcomb, leader of the US Army Institute of Surgical Research, and Dr. Howard Champion, a civilian faculty member at the Uniformed Services University – to analyze USSOCOM’s battlefield fatalities in Iraq and Afghanistan. Based on official documents and autopsy findings, they determined that almost 15% of deaths were involved potentially survivable wounds, mainly uncontrolled bleeding from injured limbs.
Prompted by these findings, USSOCOM mandated that all special operations combatants carry TCCC equipment, including updated tourniquets and clot-busting battlefield dressings. Two Delta Force medics created the “combat application tourniquet” which they adopted after testing by the US Army Institute of Surgical Research confirmed that it reliably stops arterial bleeding. After the widespread use of this tourniquet, the number of deaths from extremity hemorrhage decreased by two-thirds. In the 75th Ranger Regiment, an elite unit that trained all its medics and fighters to a high level, the number of preventable deaths fell to zero.
Impact on victim survival
During his eleven-year tenure as chairman of the DoD’s Committee on Tactical Combat Casualty Care, Dr. Butler and his colleagues transformed our military’s approach to battlefield care. TCCC and other innovations Conceived and deployed during the conflicts in Afghanistan and Iraq, the U.S. military health care system helped reduce the death rate from serious battlefield injuries in half to the lowest level in the history of warfare. Today, TCCC is the standard of care throughout the US military. It has also been adopted by many allied militaries, government agencies, law enforcement and a growing number of civilian ambulance services.
Commendations from colleagues
The selection of Dr. Butler earned high praise from the military medicine community.
Just like Dr. Butler, retired Col. Bob Mabry began his military career in Special Operations. Mabry, a Green Beret medic, was awarded the Silver Star – later elevated to a Distinguished Service Cross – for his heroism during the Battle of Mogadishu. He was then accepted into the Uniformed Services University School of Medicine and became one of the Army’s top emergency physicians. He worked closely with Dr. Butler to develop and advance TCCC.
In response to the news of Dr.’s selection. Butler noted, “There are very few individuals who can make contributions that span generations. TCCC has not only saved countless lives over the past twenty years; Frank’s work will save the lives of servicemen and women not yet born in future wars yet to be fought.”
Col. (Dr.) Vik Bebarta, an Air Force emergency physician with four combat deployments who now directs the University of Colorado Center for COMBAT Research said, “Frank Butler fundamentally transformed battlefield medicine. He and his TCCC colleagues ensured that every American military member has the best chance of survival, even in austere and dangerous environments. His legacy not only lives on in the military, but also in civilian prehospital care.”
“A story with a great ending”
Last year, Dr. Butler and two co-authors put together a history of the personalities, politics, and innovations that drove TCCC’s adoption in a highly readable book. In honor of countless Army and Air Force medics and Marine Corps members who have received poignant pleas from critically wounded warriors to “please tell my family I love them,” the book is aptly titled: Tell them yourself: it’s not your day to die.
“Tell Them Yourself: It’s Not Your Day to Die” Published by Breakaway Media, LLC, 2024
Retired Admiral William McRaven, former commander of US Special Operations Command and architect of the attack on Osama Bin Laden, made the following comments in the book’s foreword:
“From the start, this seemed like an unwinnable fight. A cast of unlikely heroes: a SEAL-turned-ophthalmologist, a Green Beret medic, a young army doctor, and several tough-as-nails combat leaders trying to challenge hundreds of years of medical dogma. How could they convince the senior medical community that everything they knew about the relief effort was wrong? How could they prove that these new procedures would save lives – not end them? During the most intense fighting since Vietnam, how could we completely rewrite the medical books? This is a story with a great ending. And it’s a story that captures the best of what makes us Americans. Never in my life have I had the honor of recommending a book to a reader.”
Throughout our country’s history, innovations designed by military health professionals have been adopted by civilian medicine and public health for the benefit of patients in the US and worldwide. By Dr. Frank Butler, President Biden also honored the many military health professionals who have worked tirelessly to develop, refine and expertly deliver Tactical Combat Casualty Care.