We have learned a tremendous amount from the past 10+ years of warfare. Significant advances have developed in the medical field. Compressed gauze, Quick Clot Combat Gauze, hemostatic bandages, Asherman chest seals, and CO2-charged bone injection IVs are some of the most modern and popular items carried today by those in the special operations community. Although this equipment can be expensive on the commercial market, I strongly recommend that you build yourself a quality first aid kit. I commonly transfer mine from my vehicle to home. Keep in mind that arid weather can deteriorate most packaged medical gear.
Here are some pictures of my medical bag. I will point out a few tips that can aid you during an urgent response. Keep in mind that the best way is usually whatever makes you the most comfortable. Practice and rehearse.
The standards of care applied to the battlefield have always been based on civilian care principles. These principles, while appropriate for the civilian community, often do not apply to care on the battlefield. Tactical Combat Casualty Care has been approved by the American College of Surgeons and the National Association of EMTs.
Make sure you perform the correct intervention at the correct time in the continuum of combat care. A medically correct intervention performed at the wrong time in combat may lead to further casualties.
Pre-hospital care continues to be critically important. Up to 90 percent of all combat deaths occur before a casualty reaches a medical treatment facility (MTF). Factors influencing casualty care include:
- Enemy and hostile fire
- Medical equipment limitations
- Widely variable evacuation time
- Casualty transportation
Stages of care
Care under fire is the care rendered by the medic at the scene of the injury while he/she and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the person or the medic in the aid bag. Wounded persons who are unable to fight should lie flat and motionless if no cover is available, or move as quickly as possible to any nearby cover.
Control of hemorrhage is important since injury to a major vessel can result in hypovolemic shock in a short timeframe. You can bleed out and die from a femoral wound in under 90 seconds.
Over 2,500 deaths occurred in Vietnam secondary to hemorrhage from an extremity wound. Use of tourniquets to stop the bleeding is essential in these types of casualties.
Key points to remember when acting as medic:
- Try to keep yourself from being shot
- Try to keep the casualty from sustaining any additional wounds
- Airway management is generally best deferred
- Stop any life-threatening hemorrhage on a limb using a tourniquet
- Reassure the casualty
Tactical field care is the care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred, but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by medical personnel. Time to evacuation to an MTF may vary considerably.
The tactical field care phase is distinguished from the care under fire phase by way of there being more time available to provide care and a reduced level of hazard from hostile fire. The times available to render care may be quite variable.
In some cases, tactical field care may consist of rapid treatment of wounds with the expectation of a re-engagement of hostile fire at any moment. In some circumstances, there may be ample time to render whatever care is available in the field. The time to evacuation may vary from 30 minutes to several hours.
Open the airway with a jaw-thrust maneuver. If the casualty is unconscious, insert a nasopharyngeal airway and place the casualty in the recovery position. Traumatic chest-wall defects should be closed with an occlusive dressing without regard to venting one side of the dressing or use an Asherman chest seal. Place the casualty in the sitting position if possible. Progressive respiratory distress secondary to a unilateral penetrating chest trauma should be considered a tension pneumothorax, and should be decompressed using a 14-gauge needle. Tension pneumothorax is the second leading cause of preventable death on the battlefield.
Any bleeding site not previously controlled should now be addressed. Only the absolute minimum of clothing should be removed. Significant bleeding should be controlled using a tourniquet as described previously. Once the tactical situation permits, consideration should be given to loosening the tourniquet and using direct pressure, hemostatic dressings, or Combat Gauze to control any additional hemorrhage.
There are many opinions and techniques used to treat casualties. New information and innovation advances the techniques we use to save lives. Consider these points to supplement your skill set. You too can save a life.
Originally published on SOFREP and written by
*Featured photo courtesy of AP Images