sion of pre‐hospital medicine, but also the provision of tactical medicine. Contextual differences in operations must be considered. For instance, the military medic usually has a well‐ planned system in place before a mis‐ sion “rolls out.” In the law enforce‐ ment support role, the medic may only have minutes notice before the SWAT team hits multiple residences simulta‐ neously. This kind of ad hoc approach is a reality of the job as police sometimes move on an instant’s notice.
Military operations are going to be much longer than police operations. That alone poses different challenges to the planning process. Shorter opera‐ tions are frequently ad hoc as previously mentioned while longer and often‐larg‐ er missions conducted by the military are often more carefully planned out.
Tenets Of Tactical Casualty Care Nearly every EMS provider knows the
mantra “scene safe, BSI, how many patients, etc.” Those are the primary questions we process each time our units arrive on scene of a call. That mantra fits the conventional role of the EMS provider. In 1996 the first paper was published by the military, which proscribed the tenets of tactical casual‐ ty care. These tenets, like the EMS mantra are the basis by which tactical care is provided. These tenets give providers critical thinking guidelines when under stress to aid them in mak‐ ing the most effective decisions for casualty care and rescuer safety. Tactical Combat Casualty Care (TCCC) begins with establishing three distinct phases of casualty care from the point of wounding (POW). The first phase, care under fire (CUF), is characterized by the casualty and rescuer being under fire or under the imminent threat of hostile fire. The primary concerns in this phase are mission completion (return fire), neutralization of the
threat and/or movement to cover. Medical interventions during this phase are minimal.
Once under effective cover or out of the zone of active or imminent fire, the provider and casualty now enter the tactical field care phase. Still in the aus‐ tere field condition, the medic must rely on experience and innovation to pro‐ vide the best care and evacuation deci‐ sions for the casualty. Within this phase of care some advanced interventions are accomplished, but resources are still limited and therefore selection of pro‐ cedures that will be done will be based on the availability of those resources in the field. For instance, intubation and fully immobilizing a patient many not be feasible because it is not likely that a long‐board was carried into the forward line of tactics and both of these proce‐ dures are time and resource intensive. The most advanced care starts during the tactical evacuation phase of care.
(CONTINUED ON PAGE 28)
EMSPROMAG.com 27
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52