Skip to main content
SpringerLink
Log in

Tactical Trauma Care

  • Chapter
  • First Online:
Textbook of Acute Trauma Care

  • 2158 Accesses

Abstract

Tactical trauma care is required in response to incidents on home soil, just as it is on the military battlefield. As a scene evolves, priorities change in terms of patient management and the appropriateness of interventions. To meet these needs, there are different levels of medical expertise and training required. There is an increasing role for the general public in response to these incidents and recognition that bystanders can deliver immediate lifesaving interventions. Care under fire takes place in the non-permissive environment and addresses only major haemorrhage and airway management. This is delivered mainly by non-vocational providers. Tactical field care, including a full MABCD assessment, occurs in the semi-permissive environment. There are multiple human factors and systems challenges in the tactical environment compared to the conventional medical environment, which leads to new considerations in team and equipment management. There is also a need to consider the CBRNE3T threat in the tactical environment and apply the SAFE approach to multiple casualties.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Butler FK. TCCC updates: two decades of saving lives on the battlefield: tactical combat casualty care turns 20. J Spec Oper Med. 2017;17(2):166–72.

    Article  Google Scholar 

  2. Callaway DW. Translating tactical combat casualty care lessons learned to the high-threat civilian setting: tactical emergency casualty care and the Hartford consensus. Wilderness Environ Med. 2017;28(2):S140–5.

    Article  Google Scholar 

  3. Hartley F, Howells A, Thurgood A, Hall F, Porter K. Medical training for police officers in specialist role (D13): a retrospective review of patient report forms from 2010–2015. Trauma. 2018;20(1):20–4.

    Article  Google Scholar 

  4. Graham D. Marauding terrorist firearms’ attacks: a Practitioner’s view of the UK’s emergency service initial response arrangements to Deal with an active shooter. RUSI J. 2018;163(2):42–50.

    Article  Google Scholar 

  5. Ranstorp M. ‘Lone Wolf Terrorism’. The Case of Anders Breivik. S+F. 2013;31(2):87–92.

    Google Scholar 

  6. Service Médical du RAID. Tactical emergency medicine: lessons from Paris marauding terrorist attack. Crit Care. 2016;20(1):37.

    Article  Google Scholar 

  7. Frickmann H, Sturm D, Finke E-J. Risks of Infection as a Result of Foreign Tissue Implantation Injuries and Sexual Violence in Asymmetric Conflicts [Internet]. military-medicine.com. 2019 [cited 2020 Aug 5]. Available from: https://military-medicine.com/article/3675-risks-of-infection-as-a-result-of-foreign-tissue-implantation-injuries-sexual-violence-in-asymmetric-conflicts.html

  8. Kao RL, McAlister VC. Care of victims of suicide bombing. Can J Surg. 2018;61(6):S184–7.

    Google Scholar 

  9. Eshkol Z, Katz K. Injuries from biologic material of suicide bombers. Injury. 2005;36(2):271–4.

    Article  Google Scholar 

  10. Defence Medical Services. Joint Service Publication 950 [Internet]. Ministry of Defence; 2016. Available from: https://www.gov.uk/government/publications/operational-patient-care-pathway

  11. JESIP. Joint doctrine: The interoperability framework. Edition 2. [Internet]. JESIP; 2016 [cited 2020 Aug 5]. Available from: https://www.jesip.org.uk/joint-doctrine

  12. Khorram-Manesh A, Plegas P, Högstedt Å, Peyravi M, Carlström E. Immediate response to major incidents: defining an immediate responder! Eur J Trauma Emerg Surg [Internet]. 2019 Apr 5 [cited 2020 Aug 5]; Available from: http://link.springer.com/10.1007/s00068-019-01133-1

  13. Hodgetts TJ, Thurgood A, Porter K, Mahoney PF. CitizenAID [Internet]. citizenAID. [cited 2020 Aug 5]. Available from: https://www.citizenaid.org/citizenaid

  14. Stop The Bleed [Internet]. Stop The Bleeding Coalition. [cited 2019 Aug 26]. Available from: https://stopthebleedingcoalition.org/

  15. Zwislewski A, Nanassy AD, Meyer LK, Scantling D, Jankowski MA, Blinstrub G, et al. Practice makes perfect: the impact of stop the bleed training on hemorrhage control knowledge, wound packing, and tourniquet application in the workplace. Injury. 2019;50(4):864–8.

    Article  Google Scholar 

  16. British Army. Health Service Support to Land Operations Handbook. Version 1, Edition 1. Ministry of Defence; 2019.

    Google Scholar 

  17. Metzger JC, Eastman AL, Benitez FL, Pepe PE. The lifesaving potential of specialized on-scene medical support for Urban tactical operations. Prehosp Emerg Care. 2009 Jan;13(4):528–31.

    Article  Google Scholar 

  18. Kyle T, le Clerc S, Thomas A, Greaves I, Whittaker V, Smith JE. The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective. J R Army Med Corps. 2016;162(6):460–4.

    Article  Google Scholar 

  19. Schwartz R, Lerner B, Llwewllyn C, Pennardt A, Wedmore I, Callaway D, et al. Development of a national consensus for tactical emergency medical support (TEMS) training programs--operators and medical providers. J Spec Oper Med. 2014;14(2):122–38.

    Article  Google Scholar 

  20. Cadarette B, Blanchard L, Staab J, Kolka M, Sawka M. Heat stress when wearing body armour. US Army Research Institute of Environmental Medicine; 2001. p. 20.

    Book  Google Scholar 

  21. Lehmacher EJ, Jansing P, Kupper T. Thermophysiological responses caused by ballistic bullet-proof vests. Ann Occup Hyg. 2007;51(1):91–6.

    CAS  PubMed  Google Scholar 

  22. Adams JD, McDermott BP, Ridings CB, Mainer LL, Ganio MS, Kavouras SA. Effect of air-filled vest on exercise-heat strain when wearing ballistic protection. Ann Occup Hyg. 2014;58(8):1057–64.

    CAS  PubMed  Google Scholar 

  23. Tomes C, Orr RM, Pope R. The impact of body armor on physical performance of law enforcement personnel: a systematic review. Ann Occup Environ Med [Internet]. 2017 16 [cited 2020 June 3]:[29 p.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434519/

  24. Larsen B, Netto K, Aisbett B. The effect of body armor on performance, thermal stress, and exertion: a critical review. Mil Med. 2011;176(11):1265–73.

    Article  Google Scholar 

  25. Dempsey PC, Handcock PJ, Rehrer NJ. Impact of police body Armour and equipment on mobility. Appl Ergon. 2013 Nov;44(6):957–61.

    Article  Google Scholar 

  26. Kollock RO, Hale D, Vogelpohl R, Kremer L, Horner J, Cox C, et al. The influence of body armor on balance and movement quality. Int J Exerc Sci. 2018;11(1):648–56.

    PubMed  PubMed Central  Google Scholar 

  27. Arnold JL, Halpern P, Tsai M-C, Smithline H. Mass casualty terrorist bombings: a comparison of outcomes by bombing type. Ann Emerg Med. 2004;43(2):263–73.

    Article  Google Scholar 

  28. de Knegt C, Meylaerts SAG, Leenen LPH. Applicability of the trimodal distribution of trauma deaths in a level I trauma Centre in the Netherlands with a population of mainly blunt trauma. Injury. 2008;39(9):993–1000.

    Article  Google Scholar 

  29. Bardes JM, Inaba K, Schellenberg M, Grabo D, Strumwasser A, Matsushima K, et al. The contemporary timing of trauma deaths. J Trauma Acute Care Surg. 2018;84(6):893–9.

    Article  Google Scholar 

  30. Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent). 2010;23(4):349–54.

    Google Scholar 

  31. Belmont PJ, Goodman GP, Waterman B, DeZee K, Burks R, Owens BD. Disease and nonbattle injuries sustained by a US Army brigade combat team during operation Iraqi freedom. Mil Med. 2010;175(7):469–76.

    Article  Google Scholar 

  32. Agency I of M (US) MF-U, Joellenbeck LM, Russell PK, Guze SB. Risks to Deployed Forces [Internet]. Strategies to Protect the Health of Deployed US Forces: Medical Surveillance, Record Keeping, and Risk Reduction. National Academies Press (US); 1999 [cited 2020 Aug 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225082/

  33. Le TD, Gurney JM, Nnamani NS, Gross KR, Chung KK, Stockinger ZT, et al. A 12-year analysis of nonbattle injury among US Service members deployed to Iraq and Afghanistan. JAMA Surg. 2018;153(9):800–7.

    Article  Google Scholar 

  34. Sanchez JL, Craig SC, Kohlhase K, Polyak C, Ludwig SL, Rumm PD. Health assessment of US military personnel deployed to Bosnia-Herzegovina for operation joint endeavor. Mil Med. 2001;166(6):470–4.

    Article  Google Scholar 

  35. Defence Statistics (Branch). Types of Injuries Sustained by UK Service Personnel on Op HERRICK in Afghanistan, 1 April 2006 to 30 November 2014 [Internet]. London: Ministry of Defence; 2016 Feb [cited 2020 Aug 5]: [12 p.]. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwj_5oHj9IPrAhWGYMAKHU8QDRwQFjAFegQIBxAB&url=https%3A%2F%2Fassets.publishing.service.gov.uk%2Fgovernment%2Fuploads%2Fsystem%2Fuploads%2Fattachment_data%2Ffile%2F502888%2F20160223_Afghanistan_Types_of_Injuries_Official_Statistic_Final_OS.pdf&usg=AOvVaw0hAqTF_sY-aF6ADq7eMtrb

  36. McKee KT, Kortepeter MG, Ljaamo SK. Disease and nonbattle injury among United States soldiers deployed in Bosnia-Herzegovina during 1997: summary primary care statistics for operation joint guard. Mil Med. 1998;163(11):733–42.

    Article  Google Scholar 

  37. Chilcott RP, Larner J, Matar H. UK’s initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals. Emerg Med J. 2019;36(2):117–23.

    PubMed  Google Scholar 

  38. Home Office. Initial Operational Response to a CBRN Incident [Internet]. Home Office; 2015 [cited 2020 June 3]. Available from: https://www.jesip.org.uk/uploads/media/pdf/CBRN%20JOPs/IOR_Guidance_V2_July_2015.pdf

  39. Byers M, Russell M, Lockey DJ. Clinical care in the ‘hot zone’. Emerg Med J. 2008;25(2):108–12.

    Article  CAS  Google Scholar 

  40. Ramasamy A, Midwinter M, Mahoney P, Clasper J. Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma. Injury. 2009;40(12):1342–5.

    Article  Google Scholar 

  41. Moorhouse I, Thurgood A, Thurgood A, Walker N, Cooper B, Mahoney PF, et al. A realistic model for catastrophic external haemorrhage training. BMJ Military Health. 2007;153(2):99–101.

    CAS  Google Scholar 

  42. Lee C, Porter KM. Tourniquet use in the civilian pre-hospital setting. Emerg Med J. 2007 Aug;24(8):584–7.

    Article  CAS  Google Scholar 

  43. Battlefield Advanced Trauma Life Support Course Manual. Department of Distributed Training, Defence School of Healthcare, Defence Medical Academy. Crown Copyright 2021.

    Google Scholar 

  44. Green-on-Blue Attacks in Afghanistan: The Data | RealClearDefense [Internet]. [cited 2020 June 2]. Available from: http://www.realcleardefense.com/articles/2017/03/21/green-on-blue_attacks_in_afghanistan_the_data_111015.html

  45. Corera G. What lies behind Afghanistan’s insider attacks? BBC News [Internet]. 2013 Mar 11 [cited 2020 June 2]; Available from: https://www.bbc.com/news/world-asia-19633418

  46. International Committee of the Red Cross (ICRC). Geneva Convention Relative to the Protection of Civillian Persons in Time of War (Fourth Geneva Convention) [Internet]. International Committee of the Red Cross (ICRC); 1949 [cited 2020 June 2]. Available from: https://www.refworld.org/docid/3ae6b36d2.html

  47. Red Cross: Health, Aid Workers Face Unabated Attacks | Voice of America - English [Internet]. VOA News. 2019 [cited 2020 June 3]. Available from: https://www.voanews.com/middle-east/red-cross-health-aid-workers-face-unabated-attacks

  48. Izade E. Red Cross volunteers attacked in Guinea while trying to bury an Ebola victim. Washington Post [Internet]. 2104 Sep 24 [cited 2020 June 3]; Available from: https://www.washingtonpost.com/news/to-your-health/wp/2014/09/24/red-cross-volunteers-attacked-in-guinea-while-trying-to-bury-an-ebola-victim/

  49. Farmer B. Taliban ‘will no longer protect Red Cross staff in Afghanistan’. The Telegraph [Internet]. 2019 Jun 12 [cited 2020 June 3]; Available from: https://www.telegraph.co.uk/global-health/terror-and-security/taliban-will-no-longer-protect-red-cross-staff-afghanistan-amid/

  50. Bricknell MC, Hanhart N. Stability operations and the implications for military health services support. J R Army Med Corps. 2007;153(1):18–21.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Royal Army Medical Corps, Leuchars, UK

    Hannah M. Clancy

  2. Royal Army Medical Corps, Catterick Garrison, UK

    Alexander G. Porthouse

Authors
  1. Hannah M. Clancy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander G. Porthouse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hannah M. Clancy .

Editor information

Editors and Affiliations

  1. Tactical Medical Wing, Royal Air Force, Brize Norton, Oxfordshire, UK

    Peter Lax

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Clancy, H.M., Porthouse, A.G. (2022). Tactical Trauma Care. In: Lax, P. (eds) Textbook of Acute Trauma Care . Springer, Cham. https://doi.org/10.1007/978-3-030-83628-3_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-83628-3_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-83627-6

  • Online ISBN: 978-3-030-83628-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation