104th Fighter Wing boosts medical readiness through the Wing’s first dual tier Tactical Combat Casualty Care training

BARNES AIR NATIONAL GUARD BASE, Mass. – The104th Fighter Wing’s Medical Group conducted simultaneous Tier 2 and Tier 3 Tactical Combat Casualty Care (TCCC) training for the first time from Aug. 18–23 here, strengthening its medical readiness and regional interoperability.

The multi‑day training brought together Airmen from across the Wing and region, including medical personnel from the 157th Air Refueling Wing medical group and the 158th Fighter Wing medical group, as well as explosive ordnance disposal (EOD) Airmen from the 104th Fighter Wing.

TCCC, the Department of Defense’s standard for battlefield trauma response, prepares Airmen to provide lifesaving care in unpredictable environments. Tier 2 focuses on foundational trauma skills, while Tier 3 expands into advanced, scenario‑driven care under fire.

“Working with Tier 2 and Tier 3 is really important because your Tier 2 is a deployment requirement,” said U.S. Air Force Tech. Sgt. Cassandra Wachowiak, a Tier 2 instructor from the 157th Air Refueling Wing Medical Group. “Everybody going downrange should have the ability to do basic things like your tourniquets and wound packing while your Tier 3 is a little bit more advanced. [Tier 3 medics] can [perform tasks] such as cranks, intravenous (IVs) and intraosseous (IO) access lines. Being able to utilize the individuals that can do certain skills so [the medics] can focus on major life saving techniques gives the patient a better chance of survival.”

Hosting both tiers concurrently allowed instructors to synchronize curriculum, streamline resources and build a more cohesive medical response force.

“The goal is to make sure that our people are ready to do their job in the worst-case scenario, and that we can bring as many people home alive,” said U.S. Air Force Tech. Sgt. Tim Ramos, the TCCC Program Manager from the 104th Fighter Wing Medical Group. “We don't deploy just with our unit; we deploy with other units, and we want to bring everyone home. So, military wide, we want to bring our [service members back safely] in through unit readiness”

Throughout the week, students trained in the Medical Group classrooms and navigated a demanding schedule that included classroom instruction, trauma lanes and physically intensive tasks, such as litter carries, mannequin drags and simulated casualty movement.

Airmen said the joint training environment strengthened teamwork and broadened their understanding of the mission, particularly as medical personnel, EOD specialists and Airmen from different states worked side by side.

“I rely on my Tier 2s, because it's a whole new learning environment,” said U.S. Air Force Staff Sgt. Gillian Gosselin, a Tier 3 student from the 157th Air Refueling Wing Medical Group. “I ask myself, ‘What can you do and what can't you do?’ And they have to kind of pull me back to Earth.” The training culminated in a high‑intensity exercise, which required students to apply their learned skills in various scenarios designed to replicate combat conditions.

“[EOD] has some of this medical training, but going through the training to this extent is super valuable for us,” said U.S. Air Force Tech. Sgt. Randy Burlingame, a Tier 2 student from EOD at the 104th Fighter Wing. “Some guys are having to do these skills in the real world, so being able to practice and run through all the motions in a simulated environment is going to be very helpful for us.”

Instructors evaluated students on communication, coordination, medical proficiency and their ability to maintain composure under pressure.

“If we can stress them out to where they can fail, when they get downrange or are put in that environment, they will be able to react and know that they can do this,” said Ramos.

For the 104th Fighter Wing, hosting the dual‑tier training reflects a broader commitment to strengthening medical capability and ensuring Airmen are prepared for the demands of modern operations, while also providing a unique opportunity to work together in a combined environment with people who hold various levels of medical training as well as personnel with different job skillsets.

“[Integrating] adds another level of training, but I think it also adds a level of understanding on how we all actually integrate and work together,” said U.S. Air Force Chief Master Sgt. Timothy Mutti, the senior enlisted leader for the 104th Fighter Wing Medical Group.

Mutti emphasized the importance of continued collaboration and engaging in recurring opportunities to enhance medical readiness across the region, learn to operate outside of their traditional duties and effectively work with others during missions.

“Multi-capable Airmen, or next-level Airmen, are tasked to do things outside of what we would think our scope is,” said Mutti. “At the end of the day, we're all here to do the job and take care of each other, and this [training] highlights that, allows us to actually see [the results], and then utilize it.”

By hosting Tier 2 and Tier 3 TCCC training concurrently and integrating both tiers into a joint exercise, the 104th Fighter Wing strengthened its medical readiness posture, expanded regional capability, and ensured Airmen remain prepared to deliver lifesaving care in any environment.

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