Tactical medicine
by: Brian P Pasquale, MPH, NREMT-P Introduction
What is tactical medicine? If you ask providers on the street, some would say “SWAT medics” or “Army Medics” and so on. The truth of the matter is that tactical medicine is a contextual approach (remember this term) to the provision of medicine with the ultimate goals of achieving current medical stan‐ dards under austere conditions. Why “tactical medicine?” Referring back to the term “contextual approach,” we find reasoning for the development of tactical medicine as a pre‐hospital specialty. Before the 1960s, medicine in the US was strictly centered in the healthcare facility with the exception of the military context. Organized in the late 60s, EMS was par‐ tially a result of Public Law 89‐563, “National Traffic and Motor Safety Vehicle Act”. The law was enacted in part, due to a study conducted by the Division of Medical Sciences, Committee on Trauma and Committee on Shock in 1966 identifying the need to push medicine to the scene of acci‐ dental death and injury. It also pro‐ scribed requirements for this new hybrid of fire, rescue and medical capa‐ bilities to have “proper training, com‐ munications and effective medical oversight” (Dean & Messoline, 2011). Since the 1960s, we’ve come “full cir‐ cle” to identify new contextual approaches to the provision of pre‐hos‐
pital medicine, resulting in sub‐special‐ ties (disaster medicine, flight medicine, haz‐mat special operations, etc.) within the EMS profession. Tactical medicine is simply another contextual subspe‐ cialty of pre‐hospital medicine, whether performed in civilian EMS, military med‐ ical or other austere operational envi‐ ronment. Tactical medicine, as a new hybrid of pre‐hospital medicine requires participating personnel to have “proper training, communications and effective medical oversight.” Does this sound familiar?
Background
The military learned difficult and costly lessons regarding the contextual approach to the provision of medicine, specifically in the early 1990’s. Prior to that time, the military struggled to keep its medical personnel up to date on their medical skills due to restric‐ tions involving the credentialing processes and the military medic. Attempts to credential military medics so they could do proficiency training in civilian facilities during peacetime led to the military to focus their training on civilian EMS curricula. Military medics began certification processes to become EMT’s and their training focused on conventional medical and nursing skills.
Contextual problems arise from the use of conventional medical methods
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