MARINE CORPS BASE CAMP LEJEUNE, N.C. -- 2nd Marine Logistics Group became the first-ever Marine Corps command to host a Tier IV Tactical Combat Casualty Care course at Marine Corps Base Camp Lejeune, July 14-25, 2025.

The course, meant to train advanced-level providers how to conduct casualty procedures in austere environments, was also the first conducted by U.S. Navy personnel on the East Coast.

“Medicine is a perishable skill, no matter who you are. It is very important to keep fresh on our skills, the same way the Marines go to the rifle range every year,” said U.S. Navy Petty Officer 1st Class Luke Brochu, instructor for the Tier IV TCCC course.

Tier IV TCCC is the highest level of tactical combat casualty care training intended for advanced medical providers such as doctors, nurses, and independent duty corpsmen. Unlike Tier I-III courses, which focus on basic and intermediate skills, Tier IV prepares providers to perform under extreme battlefield conditions with limited equipment and to make critical decisions independently to save lives by incorporating more modernized, realistic training scenarios.

“We have used a lot of input from the Tier III courses to make the training better,” said Brochu, who has been teaching combat casualty care for 15 years. “Previously, medication administration was often simulated. Now, instead of notionally [providing] medications, we have real medication kits with real labels. This allows for your med. bag to look very similar to what you would have in real life.”

Over the two-week course, students are assessed on critical trauma care protocols guided by the MARCH acronym: massive hemorrhage, airway, respiration, circulation, hypothermia/head injury. Students also learn how to report a nine-line protocol for requesting medical evacuations, and MIST reports, which are important to communicate critical information about the patient’s condition.

“The course builds on [MARCH-PAWS] concepts by adding more integrated provider-level skills that they could use in their toolkits as needed to treat patients,” said U.S. Navy Lt. Allison Dilan, course director of the Tier IV TCCC course.

This framework assists medical personnel in prioritizing treatment in complex trauma situations. With a focus on 21st-century warfare tactics, Brochu said the driving force for the course is preparing for prolonged casualty care, setting a requirement for a regimented training program prior to combat or any deployment.

“Most providers who practice emergency medicine do so in a very controlled, clean environment or hospital. During this course, we don’t give them all of the commodities and support that they would normally have,” said Brochu.”

The training environment is intentionally designed to simulate combat conditions, incorporating factors such as low visibility, limited lighting, and ambient noise such as the sounds of screams and gunfire to replicate the “fog of war.” Students also used an animatronic medical mannequin that groaned in pain, asked for help, expressed labored breathing, and spurted simulated blood from wounds. These stressors test the students’ ability to perform lifesaving procedures under pressure.

“A lot of providers are surprised to learn that this course doesn't actually teach anything new,” mentioned Dilan. “Coming in with an open mind, ready to learn a different way of approaching casualties, is important. A lot of people can come into this course and say, ‘I already know how to intubate well,’ but do you know how to intubate someone on the ground, in a dark environment where the only thing you have is a headlamp or low visibility?”

2nd Medical Battalion Tactical Medicine Training Center, as part of the Battle Skills Training School, hosted the course for nine Navy personnel and one Coast Guard member. The students held varying skill levels and experience levels, from surgeons to emergency room doctors and family medicine physicians. II Marine Expeditionary Force is the only unit currently running the course outside of the schoolhouse and the Naval Medical Center San Diego.

“I am very excited to be part of the first Tier IV TCCC program for the Marine Corps,” said Brochu, who has served 19 years as a corpsman. “One of the things that is very important to me is making sure the future generation of medical provider and corpsmen are well prepared for what's to come.”

By introducing Tier IV TCCC training to Marine Corps commands on the East Coast, the Marine Corps continues to elevate combat medical standards, setting a baseline that aims to reduce battlefield fatalities and enhance survivability during future deployments.

“I expect that everyone that goes through this course is going to continue to further improve their skills and learn new skills after that, this [course] is just establishing a good baseline for students to build off of,” stated Brochu. “Tier IV is going to help support other future, more advanced trainings for our corpsmen and physicians.”