Tactical Medicine: Basics of Medical Care in Combat Environments

Tactical medicine is an essential component of modern warfare, on which the survival of the wounded directly depends. According to statistics from recent military conflicts, the majority of battlefield deaths can be avoided if timely and correct assistance is provided. Therefore, the importance of tactical medicine on the battlefield is hard to overestimate, as it is necessary not only for military personnel but also for civilians living in high-risk conditions. In this article, we will examine what tactical medicine is, how to organize assistance in combat conditions, and which algorithms are important for stabilizing and maintaining human life.

What is tactical medicine?

Tactical medicine is a comprehensive system of rules for providing medical care in combat conditions or any other dangerous environment where there is an increased threat to the life of both the casualty and the rescuer.

Modern medicine in military conditions is formed in accordance with the Tactical Combat Casualty Care (TCCC) protocol developed in the USA, which is widely used all over the world, including in Ukraine.

This complex of measures is designed to reduce the loss of human life and maximize the preservation of the functionality of the wounded. Assistance is provided in difficult conditions with limited resources and lack of access to medical equipment.

Principles of tactical medicine:

• priority is saving life, not full medical treatment;
• rapid elimination of primary causes that can lead to death (bleeding, breathing);
• adaptation to military operations and difficult conditions of assistance;
• minimization of risks for the soldier or medic providing first aid.

Medical assistance in combat conditions differs significantly from civilian medicine. The emphasis here is not on perfection, but on speed and efficiency of action, and the maximum stabilization of the soldier/civilian condition.

The importance of knowing the basics of tactical medicine lies in enabling a soldier or medic to react correctly and quickly to an emergency in the event of a comrade being wounded, carrying out effective actions to restore their combat effectiveness and prevent death.

Providing medical assistance in combat and difficult conditions

In combat conditions, the provision of medical assistance is possible under the influence of stress, limited time, and danger. The process of assistance during military operations has certain standards and algorithms that differ depending on the specifics of the aid.

TCCC divides this process into three key phases:

1. Care Under Fire: during this phase, assistance is provided by a soldier, rescuer, or another fighter at the point of injury. Military operations continue, and access to medical equipment is limited to what can be found in the first aid kit.
2. Tactical Field Care: this phase involves providing assistance in the combat zone, but with the possibility of moving to cover to avoid combat damage. For example, in a basement, dugout, or other temporary shelter. Pre-medical assistance is provided either by a medic or another fighter who checks for critical bleeding, breathing capability, and helps to combat shock or prevent hypothermia.
3. Tactical Evacuation Care: this phase refers to assistance during evacuation, for example, in territory located beyond the line of fire. Assistance is provided by specialized evacuation teams; there is access to limited but stable field medicine. After this phase, the wounded are handed over directly to professional medics.

Note that in difficult conditions where there is an increased threat to life, it is necessary to act decisively, know how to use limited resources, and work in small and often uncomfortable spaces. Field medicine takes into account the possibility of repeated shelling, as well as the need to make important decisions regarding the soldier's condition in circumstances where a full diagnosis of their health is impossible.

Procedure for assisting casualties on the battlefield

Modern tactical medicine offers a wide range of means and techniques for assisting casualties. TCCC offers a methodology and a step-by-step algorithm of actions, on which the foundations of medical assistance for NATO countries and Ukraine are built.

The algorithm has the acronym MARCH, which defines the sequence of actions and contains recommendations for providing first aid to the wounded, etc.

MARCH breakdown:

• M - Massive bleeding: consists of stopping bleeding using military medical equipment such as a tourniquet;
• A - Airway: ensuring airway patency;
• R - Respiration: monitoring chest wounds;
• C - Circulation: assessing the presence of associated bleeding and the overall state of blood circulation;
• H - Hypothermia: protecting the wounded from possible hypothermia.

Field medicine based on this algorithm has a clearly defined order for providing assistance to the wounded. First and foremost, attention is paid to stopping uncontrolled bleeding, for example, as a result of limb loss or artery damage during combat/shelling. It should be noted that rapid blood loss leads to a quick loss of consciousness in less than a minute, which increases risks for the soldier.

The next stage of assistance is ensuring airway patency. At this stage, problems may arise due to foreign objects, a blocked airway (tongue), or facial trauma. According to the standard, a medic has approximately four minutes to provide assistance so as not to lose the wounded person.

At the respiration check stage, it is necessary to assess whether the chest has been damaged, which will help avoid pneumothorax. Half an hour is allocated for this stage, because if you do not manage to provide assistance and localize the problem, it can lead to the death of the wounded.

After this, one must ensure that the casualty does not fall into a state of hemorrhagic shock and has stable blood circulation throughout the body. Finally, care is provided for the wounded to avoid hypothermia.

Using the provided foundations of tactical medicine according to the MARCH algorithm, it is necessary first of all to assess the severity of the wounded person's condition, the severity of their wounds, minimize their impact on the general state, and provide assistance to stabilize the soldier.

Medical supplies for providing assistance on the battlefield

Tactical medicine uses special medical supplies that have undergone a process of adaptation to heavy and combat conditions. After all, on the battlefield, a soldier can rely only on themselves, or at best, on a comrade, having access only to an individual first aid kit.

The further life of the soldier can depend on how qualitatively and timely assistance is provided. Therefore, it is extremely important to pay special attention to the contents of the first aid kit, as well as the quality and reliability of the medical supplies within it.

Main types of medical supplies used when providing assistance on the battlefield:

• for stopping bleeding;
• for ensuring stable breathing;
• dressing materials;
• for the prevention of shock and hypothermia.

It is extremely important to have supplies from trusted brands at hand that care about saving soldiers' lives and providing high-quality medical assistance on the battlefield.

The soldier's individual first aid kit

The individual first aid kit is part of general military equipment. Just like a vest or helmet, it must be present with every soldier, because with the help of these medical supplies, it is possible to provide assistance in field conditions, stabilize the condition of the wounded, and save their life.

Among the requirements for the first aid kit are the quality of its contents, compactness, ease of carrying, and the effectiveness of the contents, which is determined by the goals and specifics of combat operations.

A standard first aid kit for a soldier includes:

• tourniquets;
• hemostatic bandages;
• wipes;
• bandages;
• occlusive seals;
• polymer adhesive plaster;
• nasopharyngeal tubes;
• eye shield;
• gloves;
• thermal insulation blanket;
• markers for recording the time of tourniquet application;
• scissors, etc.

The kit may also include medications that help take care of the soldier's condition after injuries. Among these are paracetamol, levofloxacin, and others.

When assembling a first aid kit for a soldier, several rules should be followed. It must be accessible and placed on the body so that it can be reached with one hand. It must contain only quality components, and medications must not be expired. The kit should be checked regularly, and the first aid kit should be replenished in case equipment is used.

Tactical medicine is not just a set of basic medical knowledge. It is a complex system that helps save lives in extreme conditions. The effectiveness of this type of medicine is determined by clear international standards, algorithms, and the quality of equipment.

Knowledge of the principles of field medicine and the rules for assembling a first aid kit can be critically important at any given moment. Therefore, basic medical training is extremely necessary not only for future military personnel but also for civilians.