Historical Tactical Medicine

“Fate of the wounded soldier is determined by the hand which applies the first dressing.” – Dr. Nicholas Senn, Spanish American War, 1890’s “Leading Confederate General Albert S. Johnston died due to a popliteal artery injury in the Battle of Shiloh. He bled to death…ironically, he died with a tourniquet in his pocket.” — April 7th, 1862, Civil War The past decade has shown an increasing emergence of violent events — school shooting incidents, active shooters, and drug and clandestine lab scenes — that require integrated tactical and medical interventions.  These dynamic and fluid historical tactical medicine incidents are associated with unique injury patterns that require a specialized and targeted response, however the standard civilian EMS response is often not readily adaptable to the tactical context. The tenets of tactical medicine can trace roots back to the battles fought by Napoleon’s army.  His chief surgeon Dominique Jean Larrey initiated the modern concepts of battlefield medicine, mobile field hospitals, and an army ambulance corps.  Impressed by the speed of the carriages of the French “flying artillery,” Dr. Jean Larrey developed the “ambulance volantes” — or flying ambulances — for the rapid transport of the wounded off the battlefields to definitive medical care.  This concept of immediate treatment of fallen soldiers was built upon during the Civil War by nurse Clara Barton (prior to her role in founding the American Red Cross), and Dr. Jonathan Letterman (who as medical director of the Army of the Potomac was known as the “Father of Modern Battlefield Medicine”).  Rapid evacuation of the injured was perfected during the Korean and Vietnam Wars with the implementation of specialized MASH units and medevac helicopters. In 1993, during urban operations in Mogadishu, numerous soldiers in an elite US Army Ranger regiment sustained multiple combat injuries during complex emergency operations in that area.  Many lessons were learned on the battlefield during this response, and the Committee for Tactical Casualty Care was established as a result. The committee —  comprised of military and civilian medical providers — used an epidemiological approach to establish and develop a strong science to tactical casualty management.  Shortly thereafter, the first set of tactical care guidelines were established. These guidelines are known as Tactical Combat Casualty Care (TCCC) guidelines and are reviewed and updated periodically by the committee. These are the current standards for the provision of tactical trauma care. These standards focus on rapid decision making and early intervention under austere conditions.  As the practicality of this approach has been demonstrated, these guidelines are now also being applied to an increasing number of civilian EMS operations. Tactical medical support for civilian law enforcement operations is a developing field.  Medical personnel are often cross-trained career police officers, or are traditional EMTs and paramedics that have specialized training to operate in a tactical environment.   Our goal is to provide a forum to “bridge the gap” between these professions where they can share common ground — especially when it comes to trauma casualty care.