"Tactical Field Care"

When the Fight Isn't Over, But You Can Really Help

We just talked about "Care Under Fire," which is all about super-fast, life-saving actions when danger is still immediate. But what happens once you've moved the patient (and yourself!) to a spot where the direct threat isn't right on top of you? You're still in a tactical situation, so it's not like a regular hospital, but you have a bit more breathing room.

This is where "Tactical Field Care" comes in. It's the longest and most comprehensive phase of care in Tactical Medicine. It's when you can really start to make a big difference, even without all the fancy tools of a hospital.

What is "Tactical Field Care"? The Deeper Dive

"Tactical Field Care" refers to the medical treatment given to a casualty once they are no longer under effective hostile fire or immediate direct threat. While the environment isn't perfectly safe (it's still "tactical," meaning unpredictable and potentially dangerous), you're now in a place where you can focus more on providing actual medical care.

Think of it as moving from just reacting to a bullet hitting, to thoroughly dealing with the injury it caused. You might be behind a sturdy wall, inside a secure building, or in a vehicle moving away from the immediate danger zone. The main goal here is to assess the patient thoroughly and perform all necessary life-saving interventions before they can get to a higher level of care (like a hospital).

Key Interventions: The MARCH Continues!

In "Tactical Field Care," you follow the MARCH algorithm in full. This systematic approach ensures you address the most critical problems in the right order.

Here’s what typically happens during this phase:

• M - Massive Hemorrhage: If a tourniquet was applied under fire, you'll check it to make sure it's tight and effective. For other serious bleeding not on an arm or leg (like in the groin, armpit, or neck), this is where you'd use specialized hemostatic dressings (bandages that help blood clot) and apply direct pressure or pack wounds. You'd also look for and manage internal bleeding with things like a pelvic binder for a suspected broken pelvis.

• A - Airway: Now you can really focus on making sure the patient can breathe. You'll check if their airway is open and clear. This might involve:

  • Simple head tilts or jaw thrusts.

  • Inserting an oral or nasal airway tube to keep the tongue from blocking the throat.

  • If necessary, performing a surgical airway (like a cricothyrotomy) as a last resort if the airway is blocked and other methods fail.

• R - Respiration: This is all about breathing and chest injuries. You'll:

  • Look for "sucking chest wounds" and seal them with chest seals.

  • Check for signs of a tension pneumothorax (a life-threatening collapsed lung) and perform a needle decompression if needed to release trapped air.

  • Consider giving oxygen if available and indicated.

• C - Circulation: Once bleeding and breathing are managed, you'll address shock. This involves:

  • Starting IV (intravenous) or IO (intraosseous) lines to give fluids or medications.

  • Administering fluids, ideally blood products, or specific medications like TXA (Tranexamic Acid) to help with clotting.

  • Managing pain, often with strong medications like ketamine or fentanyl.

• H - Hypothermia / Head Injury: Lastly, but very importantly, you'll:

  • Prevent hypothermia (getting too cold) by covering the patient with blankets, sleeping bags, or specialized warming systems, as cold makes bleeding and shock worse.

  • Perform a quick neurological exam to check for head injuries and monitor for changes in consciousness.

  • Immobilize the spine if a significant neck or back injury is suspected.

This phase also includes things like splinting broken bones, treating burns, and managing pain.

Still "Tactical": Important Considerations

Even though you're in a "relatively safe" spot, remember it's still a tactical environment. This means:

• Security is Ongoing: You always need to be aware of your surroundings. The threat could re-emerge at any time.

• Limited Resources: You still won't have everything a hospital does. You'll be working with the gear you brought.

• Need for Rapid Evacuation: While you're doing thorough care, the ultimate goal is still to get the patient to a hospital as quickly and safely as possible. You're trying to stabilize them for transport.

• Communication is Key: You're constantly communicating with your team about the patient's status and the plan for getting them to definitive care.

"Tactical Field Care" is truly the heart of Tactical Medicine. It's where skilled providers bring their training to bear, performing detailed assessments and critical interventions that dramatically improve a patient's chances of survival, all while still operating in challenging and unpredictable conditions. It’s about doing the most good, for the longest period, until higher care can take over.