Battlefield medicine
Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat.
This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences.
[17] Through this 3-year research, the first version of the TCCC guidelines were created to train soldiers to provide effective intervention on the battlefield.
[17] The TCCC therefore outline the appropriate usage of tourniquets to provide effective first aid on the battlefield.
[32] Tactical field care phase begins when the casualty and care-provider are no longer under imminent threat of injury by hostile actions.
[30] Major tasks that are to be completed in the tactical field care phase include the rapid trauma survey, the triage of all casualties, and the transport decision.
[30] Due to improved access to resources and the tactical situation, more advanced interventions can be provided to casualties such as endotracheal intubation.
[30] In tactical evacuation (TACEVAC), casualties are moved from a hostile environment to a safer and more secure location to receive advanced medical care.
Tactical evacuation techniques use a combination of air, ground and water units to conduct the mission depending on the location of the incident and medical centres.
[33] The list of determinants to create the TACEVAC strategy include the distances and altitudes involved, time of day, passenger capacity, hostile threat, availability of medical equipment/personnel, and icing conditions.
[33] As mentioned TACEVAC is more advanced than TCCC, it also includes training to/for:[33] There are three levels of tactical combat casualty care providers in the Canadian Armed Forces.
The course focuses on treating hemorrhages, using tourniquets and applying dressings, and basic training for casualty management.
[32] The MARCHE protocol prioritizes potential preventable causes of death in warfare as follows: Care under fire happens at the point of injury.
[36] Tactical combat casualty care recommends a tourniquet as the single most important treatment at the point of injury.
[36] It is recommended to apply a Committee on Tactical Combat Casualty Care (CoTCCC) approved tourniquet for any life-threatening extremity hemorrhages.
[36] However, unconscious casualties who are not breathing could require surgical cricothyroidotomy, as endotracheal intubation is highly difficult in tactical settings.
Tension pneumothorax (PTX) develops when air trapped in the chest cavity displaces functional lung tissue and puts pressure on the heart causing cardiac arrest.
[36] IV should be applied using an 18 gauge catheter and saline lock in tactical field care, secured by transparent would-dressing film.
Secondary brain injury is worsened by hypotension (systolic blood pressure under 90 mmHg), hypoxia (peripheral capillary oxygen saturation under 90%), and hypothermia (whole body temperature below 95 Fahrenheit or 35 Celsius).
First responders must address burns, open fractures, facial trauma, amputation dressings, and security of tourniquets.
Casualties with penetrating trauma to the chest or abdomen should receive priority evacuation due to the possibility of internal hemorrhage.
[38] These injuries are very difficult to treat given currently fielded medical therapies such as Tactical Combat Casualty Care.
[38] During the study period, there were no effective protocols put in place to control junctional or truncal sources of hemorrhage in the battlefield, which suggests a gap in medical treatment capability.
[38] This study shows the majority of battlefield casualties which occur prior to receiving surgical care are non-survivable.
[38] Another study analyzed the effectiveness of tourniquets for hemorrhage control, which are used in Tactical Combat Casualty Care.
[39] A prospective study of all trauma patients treated at the Canadian-led Role 3 multinational medical unit (Role 3 MMU) established at Kandahar Airfield Base between February 7, 2006, to May 20, 2006, was conducted to examine how Tactical Combat Casualty Care interventions are delivered.
[40] The distinction between venous and arterial tourniquets must be reinforced in Tactical Combat Casualty Care training.
[40] Tactical Combat Casualty Care courses must also train soldiers to remove tourniquets for the purposes of reassessing trauma after the patient and caregiver is no longer under enemy fire.
[40] Tactical Combat Casualty Care training must reinforce using landmarks when performing needle decompressions.
