Tactical medical considerations - Stages of care
Tactical medical considerations aren't just the team medic's problem, everyone needs to be well versed on the latest Tactics, Techniques, and Procedures (TTPs). We will discus some general concepts and considerations for combat live saving steps.
A word picture designed to take you through the some of the early on steps used when a team member is injured and you’re taking hostile enemy fire.
If during an operation a team member goes down, you have to avoid the overwhelming feeling to run directly over to them and attempt to begin medical treatment or assessment. The stages of care are:
- Care Under Fire ....
2. Tactical Field Care
3. Tactical Casualty Evacuation (TACEVAC- under hostile conditions, CASEVAC would be more of an administrative moving of a casualty, the context isn’t really important as long as it is understood we are using TACEVAC to describe an evacuation under hostile conditions. In the TACEVAC treatment and priorities of work are going to be much different than if we were in a safe area treating the same injury.)
1. Care Under Fire is the Care given to the team member while under effective hostile fires. Team members with medical functions assigned to them are first concerned with the enemy at hand. The quickest way to help the injured team member is to suppress, close with and destroy the enemy. During this same time frame the injured person is responsible for staying in the fight. Just because you are shot doesn’t mean you are given an exemption from protecting your fellow team members. The injured persons responsibilities are to assess their medical needs and begin apply self-aid i.e. a tourniquet, pressure bandage, etc. The next step is for the injured team member to move out of the line of fire if possible, next the injured team member is to continue to press the fight, return fire against the enemy if possible. If the team overcomes the threat and there is no longer effective fires on you, then moving into step 2 would be appropriate
2. Tactical Field Care is the medical assessment conducted by the team medical personnel. The team medic has shifted his focus from engaging and destroying the enemy to now providing medical field treatment to an injured team member. Assessment of the self-aid applied by the injured team member, follow on treatment and stabilization may take place at this point, preparing the injured team member for evacuation from the area is now a priority. This evacuation may be self-extraction i.e injured team member walking out on his own or it could be using load bearing devices to move the injured team member to a location of safety.
3. Tactical Evacuation is the method in which you are moving your injured team member to a higher level of follow on care or to an area which is secure enough for the team medic to solely focus on field medical procedures to further stabilize the injured team member.
3. Tactical Casualty Evacuation (TACEVAC- under hostile conditions, CASEVAC would be more of an administrative moving of a casualty, the context isn’t really important as long as it is understood we are using TACEVAC to describe an evacuation under hostile conditions. In the TACEVAC treatment and priorities of work are going to be much different than if we were in a safe area treating the same injury.)
1. Care Under Fire is the Care given to the team member while under effective hostile fires. Team members with medical functions assigned to them are first concerned with the enemy at hand. The quickest way to help the injured team member is to suppress, close with and destroy the enemy. During this same time frame the injured person is responsible for staying in the fight. Just because you are shot doesn’t mean you are given an exemption from protecting your fellow team members. The injured persons responsibilities are to assess their medical needs and begin apply self-aid i.e. a tourniquet, pressure bandage, etc. The next step is for the injured team member to move out of the line of fire if possible, next the injured team member is to continue to press the fight, return fire against the enemy if possible. If the team overcomes the threat and there is no longer effective fires on you, then moving into step 2 would be appropriate
2. Tactical Field Care is the medical assessment conducted by the team medical personnel. The team medic has shifted his focus from engaging and destroying the enemy to now providing medical field treatment to an injured team member. Assessment of the self-aid applied by the injured team member, follow on treatment and stabilization may take place at this point, preparing the injured team member for evacuation from the area is now a priority. This evacuation may be self-extraction i.e injured team member walking out on his own or it could be using load bearing devices to move the injured team member to a location of safety.
3. Tactical Evacuation is the method in which you are moving your injured team member to a higher level of follow on care or to an area which is secure enough for the team medic to solely focus on field medical procedures to further stabilize the injured team member.
Thinking back to previous medical training you may have received in the past, you will immediately focus on the fact that that first step in care under fire is for the injured person to initiate survival steps, move to cover if they can, return fire if they can, apply medical treatment such as a pressure bandage or tourniquet if they can. For context we will say the injured party has accomplished as much of step one, care under fire as possible. We are now focus back to the engagement. The team leader is assessing the situation and is making a course of action determination, such as a break contact drill which may indicate that the team is unable to push the assault, or maneuver on the enemy. In this instance the team has determined the enemy force is too great and they will break contact.
Due to overwhelming enemy numbers or overwhelming enemy firepower, the team is unable to achieve fire superiority. The Team Leader has given the break contact signal and the signal has been echoed throughout the team. In this case the team is a standard four man fireteam. This team is outfitted with standard fighting rifles and a team member with a higher level of medical training is acting as the team medic. During the break contact it is understood that we will not leave a wounded team member on the field of battle. .
Our focus is now to recovering our wounded team member. For context, the team member has pulled himself behind a small rise in the ground, taking cover behind micro terrain, he has sustained a gunshot wound to his left leg which resulted heavy squirting blood from the front of the wound site. Exposed bone is also protruding from the back side of the wound site. The injured person is able to reach his pre-positioned SOF Tactical Tourniquet-Wide (SOF-TT-W) and apply it “high and tight” to the injured leg. The tourniquet windless device is rotated until the bleeding has stopped, the windless device is secured. The injured team member has stopped the massive life threatening hemorrhaging through the use of mechanical advantage in the form of a tourniquet with a windless device. The injured person is now attempting to re-engage the enemy through well aimed rifle fires.
The 3 remaining team members are aware of the injured mans location and that he has sustained some form of injury which has taken him out of the active fight- the injured man is still attempting to provide as much “fight” as he can muster, remaining in the fight is not only providing support to the team, it is assisting in furthering the injured person's chances of reaching follow on medical attention. The remaining team is tactically breaking contact, directionality of the break contact can use many methods, fireteam lateral peel maneuver or 3 man bounding toward the injured team mate in order to facilitate a quick down and dirty single man evacuation method.
The 3 man fireteam has reached a place of sufficient cover or concealment or fire superiority allowing for the team medic to make his way to the injured team member. Two team members continue to return covering fire while the team medic is immediately taking stock of the injured person's wounds and their ability to assist in the evacuation efforts. It is clear from the quick assessment that life threatening hemorrhaging has been stopped via the tourniquet, due to the injured leg the casualty will not be able to assist with walking, the casualty will be able to assist in standing maintaining balance for a short period of time.
In this case the team medic is going to make an assessment of how to evacuate the injured party. Some of the considerations are:
Due to overwhelming enemy numbers or overwhelming enemy firepower, the team is unable to achieve fire superiority. The Team Leader has given the break contact signal and the signal has been echoed throughout the team. In this case the team is a standard four man fireteam. This team is outfitted with standard fighting rifles and a team member with a higher level of medical training is acting as the team medic. During the break contact it is understood that we will not leave a wounded team member on the field of battle. .
Our focus is now to recovering our wounded team member. For context, the team member has pulled himself behind a small rise in the ground, taking cover behind micro terrain, he has sustained a gunshot wound to his left leg which resulted heavy squirting blood from the front of the wound site. Exposed bone is also protruding from the back side of the wound site. The injured person is able to reach his pre-positioned SOF Tactical Tourniquet-Wide (SOF-TT-W) and apply it “high and tight” to the injured leg. The tourniquet windless device is rotated until the bleeding has stopped, the windless device is secured. The injured team member has stopped the massive life threatening hemorrhaging through the use of mechanical advantage in the form of a tourniquet with a windless device. The injured person is now attempting to re-engage the enemy through well aimed rifle fires.
The 3 remaining team members are aware of the injured mans location and that he has sustained some form of injury which has taken him out of the active fight- the injured man is still attempting to provide as much “fight” as he can muster, remaining in the fight is not only providing support to the team, it is assisting in furthering the injured person's chances of reaching follow on medical attention. The remaining team is tactically breaking contact, directionality of the break contact can use many methods, fireteam lateral peel maneuver or 3 man bounding toward the injured team mate in order to facilitate a quick down and dirty single man evacuation method.
The 3 man fireteam has reached a place of sufficient cover or concealment or fire superiority allowing for the team medic to make his way to the injured team member. Two team members continue to return covering fire while the team medic is immediately taking stock of the injured person's wounds and their ability to assist in the evacuation efforts. It is clear from the quick assessment that life threatening hemorrhaging has been stopped via the tourniquet, due to the injured leg the casualty will not be able to assist with walking, the casualty will be able to assist in standing maintaining balance for a short period of time.
In this case the team medic is going to make an assessment of how to evacuate the injured party. Some of the considerations are:
- resources to call for help, Quick Reaction Force (QRF)?
- evacuation resources such as vehicles or airborne assets?
- sufficient team members to assist with a 2 man carry?
- equipment to assist in a single man carry- if none use a manual single man carry
- rally point established?
- How far away is that rally point?
- is there cover and concealment in route to our rally point or leaving the immediate contact site?
- What is the terrain which the team medic will be evacuating the injured person over?
- what equipment is the injured person wearing?
- what equipment can be left behind?
- what equipment must be retained or destroyed in lieu of leaving behind?
Fireman's Carry These are but a few of the considerations the team medic will be evaluating and immediately prioritizing the most appropriate TACEVAC method available at the time.
For context, the enemy is continuing to push the fight. The environment is hot desert environment, approaching dusk. The team has identified a previous in-route rally point 200 meters directly to the rear and slightly downhill. The terrain is a mixture of small scrub tree, intermittent boulders, micro terrain- depressions and high points. The team medic has opted to strip all equipment from the injured person. For context, there are no sensitive items in the abandon equipment. The team medic has chosen a single person manual TACEVAC carry. The carry selected will be the “Firemans carry”.
Consideration for the “Firemans carry”: try not to induce any additional injuries to the casualty while employing the carry technique. Be aware of the wound site location and ensure that while placing the casualty in the carry position - no wound bandages or tourniquets are dislodged. Wound site should be down, when using the “Firemans carry”, one leg is usually used to control or hold the injured persons weight, attempting to place the wounded leg down will help prevent the wound site and any bandaging or tourniquets from being dislodged during the carry process.
For context, the enemy is continuing to push the fight. The environment is hot desert environment, approaching dusk. The team has identified a previous in-route rally point 200 meters directly to the rear and slightly downhill. The terrain is a mixture of small scrub tree, intermittent boulders, micro terrain- depressions and high points. The team medic has opted to strip all equipment from the injured person. For context, there are no sensitive items in the abandon equipment. The team medic has chosen a single person manual TACEVAC carry. The carry selected will be the “Firemans carry”.
Consideration for the “Firemans carry”: try not to induce any additional injuries to the casualty while employing the carry technique. Be aware of the wound site location and ensure that while placing the casualty in the carry position - no wound bandages or tourniquets are dislodged. Wound site should be down, when using the “Firemans carry”, one leg is usually used to control or hold the injured persons weight, attempting to place the wounded leg down will help prevent the wound site and any bandaging or tourniquets from being dislodged during the carry process.
 Pack Strap Carry |  Saddle Back Carry |  Support Carry |
A word quickly on Individual First Aid Kit (IFAK) aka the blowout kit. Observations over time have lead me to bring this up since we are talking generally about tactical medical situations. I have noticed that many IFAK kits contain chest darts aka decompression needles. When I inquire with people about the decompression needles I usually get the same response. “you just stab em in the chest”. The number of people who can accurately articulate and demonstrate where to administer a decompression needle is extremely low in my non-scientific survey / opinion. I have also noticed many people only carry one decompression needle. This is also concerning due to the fact that sometimes one is not enough.
Russell Chest Seal I don’t want to be controversial or cast accusation's, but sometimes it seems like if someone isn't carrying the same load out as the SpecOps guy in Afghanistan then they seen as just a poser. I hope that I have just run across the few exceptions to the rule and that the majority of people carrying around medical equipment -hell any war fighting equipment for that matter, are seeking qualified training. Just a thought for those who may find themselves not feeling 100% confident in using a decompression needle, go out and get numerous Russell Chest Seals or Asherman Chest Seals. Then go out and get some additional combat relevant medical training.
Being able to find the bang switch on your battle rifle is just a small portion of an overall combat effective team member. Marksmanship, tactical mindset, medical training, land navigation, fieldcraft, physical fitness, survival skills, escape and evasion, and generally just good people skills are all part of the full package. You don’t need to be an expert on everything, being the jack of all trades and master of none is often times proven to provide a much more well rounded team member.
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