Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Tactical Combat Casualty Care
The 2011 Annual Summer Meeting of the Wilderness Medical Society that was held in Snowmass, Colorado was excellent and provided terrific education for all in attendance. In a series of posts, I’ll highlight some of what we learned.
Brad Bennett gave a wonderful lecture on Tactical Combat Casualty Care (TCCC) for the Wilderness Provider. Military medicine and wilderness medicine share certain common elements: extreme and remote environments, a practice of medicine where definitive care can be hours or days away, difficult patient access, limited medical personnel and equipment, prompt decision making, creative thinking, and improvisation. Medical injuries may overwhelm resources and evacuation may be delayed due to environment conditions and the features of the terrain.
In military situations, hemorrhage is the leading cause of death on the battlefield; it also figures prominently in situations of injury in the wilderness. Of course, the major difference between military trauma care and wilderness medicine is the absence of hostile fire in the latter.
In TCCC, the main thrusts are to treat the casualty, prevent additional casualties, and complete the mission. Sometimes the latter takes priority, because good medicine can be bad tactics. Still, TCCC has helped U.S. combat medical personnel to achieve the highest casualty survival rate in history.
TCCC and wilderness medicine share and learn from each other. No agency other than the military has done more to advance the concept of the tourniquet. In addition, surgical airways are very important in TCCC. In wilderness medicine, there has been emphasis on understanding the physiology and pathophysiology of cold and altitude.
Principals and preferences to TCCC guidelines maybe useful in specific wilderness scenarios, such as:
- threat environments
- tsunamis and floods
- wild animals
- urban disasters
- penetrating and blunt trauma
- hostile threats
- hunting and firearm incidents
- knife lacerations
- falls from heights
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