In 1996, the research team published new guidelines for pre-hospital care on the battlefield and identified three areas which dictated what procedures could be performed: care under fire, tactical field care, and casualty evacuation care. In addition to recommending tourniquet use to control life-threatening hemorrhage, the guidelines also recommended changes to fluid replacement, pain control, pharmaceutical guidelines, and requirements for spinal immobilization and cardiopulmonary resuscitation for specific wounds and injuries. Finally, they recommended training programs designed to prompt critical thinking about implementing the guidelines using scenarios to confront first responders with the variety of environments, tactical conditions, and casualties they were likely to encounter. These guidelines established the foundation for Tactical Combat Casualty Care.^1,2

The Army Medical Department placed greater emphasis on developing the skills of its front-line combat medics during the late 1990s, creating a new military occupational specialty (68W) and requiring emergency medical technician certification for all soldiers holding the military occupational specialty. With the advent of the wars in Afghanistan and Iraq, the U.S. Army Institute of Surgical Research, in partnership with the U.S. Air Force and U.S. Navy, established the Joint Theater Trauma Registry (JTTR) to collect and analyze data on battlefield injury. Data from the JTTR confirmed early WDMET data leading to new research in controlling hemorrhage, resulting in the fielding of hemostatic bandages and tourniquets to soldiers in the field and instruction in their use. Tension pneumothorax and airway compromise were identified as the next two leading causes of preventable deaths, resulting in additional training for medics.²

The Army Medical Department continues to capture lessons learned on the battlefield and use them to improve pre-hospital care, increasing soldiers’ chances of surviving to reach definitive care. Many of those lessons are transferable to civilian medical practice, and Army health care professionals retiring from the military also take those lessons with them when they take up practice in a civilian health care facility.

Disclaimer: The opinions and views expressed in this article are those of the author. They are not, nor should they be implied as being endorsed by the United States Army Medical Department, United States Army, Department of Defense, or the federal government.

References

1. Butler FK Jr. Tactical Combat Casualty Care: beginnings. Wilderness Environ Med. 2017;28(2S):S12-S17.
2. Gerhardt RT, Mabry RL, De Lorenzo RA, et al. Chapter 3: fundamentals of combat casualty care. In: Combat Casualty Care: Lessons Learned from OEF and OIF. Frederick, MD: Office of The Surgeon General, Borden Institute; 2011:85-120.