Lessons Learned from a Decade of Conflict - Boekje Pienter

Rapid evacuation and transport of non-ambulatorycasualties is just one of the areas where civilian EMSagencies can learn more from the U.S. military.Photo AP / John MooreBy Jeffery S. Cain, MDIn 1996, a revolutionary concept occurred in military medicine.Until then, battlefield prehospital trauma care followedthe same guidelines developed for the urban U.S. civilianenvironment. But following the October 3, 1993, Battle ofMogadishu 1 , the U.S. Special Operations Command sponsoreda study to review how casualty care was conducted. The panel’sconsensus: Conventional civilian medicine was not appropriatefor optimizing casualty care within the tactical environment.To that end, two military physicians with extensive tacticalexperience authored a set of guidelines intended to improvecasualty care during tactical operations. 1,2 These TacticalCombat Casualty Care (TCCC) guidelines have been consistentlyreviewed and updated, and are approved by the AmericanCollege of Surgeons Committee on Trauma for inclusion in theirPre-hospital Trauma Life Support guidelines. 3A decade ago, we were attempting to applycivilian techniques to the combat environment;today, we’re examining the opposite: Are therelessons learned from tactical medicine thatmay improve or facilitate civilian prehospitaltrauma care? Although tactical medicine generallybreaks down care by tactical situation (e.g.,care under fire, tactical field care and tacticalevacuation), this article will examine the issue bycategories of trauma interventions.Hemorrhage ControlIsolated extremity hemorrhage remains theprimary cause of potentially preventable deathduring combat operations. Casualty care improvements,including better medical devices,guidelines and training down to the individualsoldier level, have focused on decreasing thiscause of mortality.Another article within this supplement(“Tourniquet First!” p.24) explores temporaryemergency tactical tourniquets in depth. Forthe purposes of this article, it’s simplest to pointout that new tourniquets, and new guidelinesfor early tourniquet use in far-forward casualtycare, are saving lives. 4 The primary tactical tourniquetrecommended by the U.S. Army Instituteof Surgical Research (USAISR) is the CombatApplication Tourniquet (C-A-T), followed by theSpecial Operations Forces Tactical Tourniquet16 War on TraumaJournal of Emergency Medical Services