Care Under Fire:Providing Treatment Behind Cover

Providing care under fire is a mentally daunting task. Few other phases have so little to do with medicine and so much to do with your surroundings. Even with a sizable piece of cover, it is easy to make mistakes and expose yourself during treatment when focused on patient care.

In the video you can see the medic doing a decent job of maintaining a low profile during treatment, then, while shifting from the casualty’s leg to his head, he elevates his body during movement. This action briefly exposes his head to enemy fire. An analogy we like to use to explain the atmosphere you are operating in when providing true “care under fire” is that it can be equated to working in confined space. The difference is that instead of bumping your head or elbow on a concrete slab, the concrete slab is replaced by incoming fire. It is generally best for everyone if the medic avoids bumping parts of his body into bullets.

The effort to maintain your position of cover is exponentially more difficult in urban areas or areas with varying points of elevation. You should regularly reassess the effectiveness of you position as the fight progresses. If the enemy force has moved to an elevated position, or possibly to the second or third story of a surrounding structure, you just lost about 50% of your position. Now you must either be more cautious when moving to provide treatment or you need to shift to maximize the use of the position you are in. If in a structure with external windows and “plunging fire” from surrounding buildings, the safest position is on an external wall, in the corners, away from windows. However, remember to consider the type of materials used to construct the building before selecting this position. This position is not recommended if in a vinyl-sided home or a 3rd world type structure.

Failure to practice working in tight quarters behind cover can lead to potentially fatal mistakes in combat. Incorporate these situations into your training and use them to increase the effectiveness of your equipment (e.g., how and where you store or pack it) and how to asses your positions.

Here are some tips for operating in this phase of tactical medicine:
-Keep items required for Care Under Fire or buddy-aid easily accessible.
-Reposition casualties to minimize their level of exposure and yours.
-Don’t lose touch with your surroundings, regularly reassess the enemy’s position.
-Don’t be afraid to move to a new position if the tactical situation allows.
-If in a structure, be mindful of interior and exterior threats.
-Keep your treatments as simple as possible then get back on your gun!

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