Tactical Emergency Medicine

• Published in: Trauma reports 2017-03, Vol.18 (2)
• Main Authors: Brian L Springer, MD, FACEP, Verbillion, Meagan
• Format: Article
• Language: English
• Subjects: Airway management; Casualties; Committees; Emergency medical care; Fatalities; Hemorrhage; Injuries; Law enforcement; Mass murders; Medicine; National security; Shootings; Surgeons; Trauma; Trauma care
• ISSN: 1531-1082; 1945-7391

EXECUTIVE SUMMARY * Advanced Trauma Life Support does not take into consideration factors such as enemy fire, equipment limitations, delayed evacuation times, temperature and weather extremes, mission considerations, and transport challenges in hostile environments. * Tactical Combat Casualty Care divides treatment into three phases of care, based on the combat environment. Care under fire is rendered by the medic or corpsman at the scene of the injury while both provider and casualty remain under hostile fire. Tactical field care is rendered once the medic and casualty are no longer under direct hostile fire. CASEVAC is the care rendered once the casualty has been picked up by an aircraft, vehicle, or boat and is transferred to the medical treatment facility. * Tactical Combat Casualty Care and its phases of care represent a huge paradigm shift in the treatment of combat casualties because they initiate treatment of combat casualties starting at the point of injury, and it provides a seamless continuity of medical support all the way to definitive care without any decrease in the level of care. * Tactical Emergency Medical Support is an out-of-hospital EMS system that focuses on medical support for law enforcement special operations missions. * Physicians can assist with resource allocation by understanding what is available in the community in terms of trauma center locations and capabilities, best methods for casualty transport to definitive care, and relevant contact numbers for local EDs and other medical resources. * The three phases of Tactical Combat Casualty Care have been augmented to fit the needs of the civilian tactical environment and include the hot zone, warm zone, and cold zone. * Tactical primary survey is a sequential series of assessments and interventions designed to provide optimal care to those suffering injury in a tactical environment. * Care addresses three major causes of mortality in the combat environment: exsanguinating hemorrhage (particularly from the extremities), tension pneumothorax, and airway obstruction.