About TacMed

Welcome to the Tactical Medical Solutions Blog. The purpose of the TacMed Blog is to serve as a conduit between combat and tactical medics in the military and law enforcement communities around the world. Our hope is that the information here will enhance your abilities to minimize preventable deaths by offering educational dialog regarding issues faced by medics in these communities. We welcome you to comment on our entries, request that specific topics be covered, and even become a guest poster.

Tactical Medical Solutions, Inc. was formed to develop quality, effective supplies and equipment for combat and tactical medicine. We knew what worked for us in that environment and wanted to share it with as many people as possible. Our products reflect our experience, situations we have faced and friends we have lost. Our goal is to prevent others from experiencing those losses by offering equipment that allows them to operate more efficiently and effectively. Minimizing preventable death in a combat or tactical environment is a realistic and attainable goal and we are proud to offer products that will help you reach it.

All of our employees are former tactical medical professionals or have a close relationship with them. We maintain close ties with some of the most elite and experienced medics in the world and every one of our products must pass their evaluation before we put our name on it. We understand the principles of human performance as it relates to combat stress and design our products to complement that performance not complicate it. This approach to product development and evaluation leads to products that truly work in combat. We don’t design products to pass a structured laboratory test in a controlled environment or barely meet a requirement as a substitute. They are designed to function when there is no structure, when you have minimal supplies and very little time. When there is no one else there to help, and you probably have more than one casualty. You are trying to save lives while someone is trying to take yours. That is the environment of the tactical health care provider and that is where our products excel.

Weapons Placement: Part II

Knowing when and where to implement various techniques is one of many important aspects of tactical medicine. In a previous entry, we discussed weapons placement during treatment. We proposed positioning your primary weapon behind your knees when the tactical situation allows. The video below is a prime example of when this technique should not be used. The medic is supposed to be in the Care Under Fire (CUF) phase. In this phase of tactical medicine, while treating in the prone position, your weapon should be immediately accessible and ready to engage threats. Due to positioning, you do not have rapid access to your secondary weapon. Slinging your weapon is not a sound choice, because its position will hinder putting it into operation. Your best choice in this situation may be to un-sling your weapon and route your arm through the sling. Don’t, however, put the sling all the way on. Next, set the weapon on your casualty, making an effort not to burn them with a hot barrel. Routing your arm through the sling maintains a point of attachment and acts as a friendly reminder; however, it doesn’t interfere with your ability to provide treatment. When you move, your weapon will still move with you and is readily accessible for periodic engagements.

Most courses teach not to use your casualty as a work table or place supplies and equipment on them. This is a good habit to get into, but this is a definite exception. Your weapon is now a lifeline for you and your casualty, and it needs to be readily accessible.

TacMed Key Points:

    1) Situation dictates weapons placement
    2)CUF phase requires your weapon to be accessible no matter your position
    3)In order to increase your and your casualty’s chance of survival, you may have to “break a rule” and use him as a table or a firing platform.

Cross-loading Medical Supplies

A medic’s bag is never big enough, but it’s always too big. There is no way for you to carry enough medical equipment in your bag to treat every possible injury. If you over pack your bag, it makes it difficult to work out of, it slows you down and it limits your ability to maneuver through the battlespace. If you under pack, you might not have the items you need to treat a serious casualty.

One way to maximize the medical supplies on the objective while minimizing the burden on the medic is to cross-load supplies. Medics carry ammunition for their weapon; operators should carry supplies for their wounds. This has been practiced for quite some time in the military, but it is just making its way into the civilian/ Law Enforcement sector. Soldiers are issued individual first-aid kits containing the essential items for initial care on the battlefield. The majority of what is needed for self-aid and/or buddy-aid is contained in these kits, and they are a great example of cross-loading on a massive scale.

When considering items for cross-loading, look at items individuals are actually trained to use and that take-up a lot of space in your bag. Bandages and tourniquets are good examples of items that are high-volume items in both use and consumption of space. Spreading these items throughout your element will be a major help in a few ways. For example:

1. It reduces the medic’s load
2. It spreads medical assets across the team reducing treatment times.
3. Increases the amount of medical supplies on the objective

Items recommended for cross-loading:

1. Bandages
2. Tourniquets
3. Chest-seals
4. Snivel meds (OTC Drugs)
5. IV fluids

Specialty items that are medic-specific tools should not be cross-loaded. These are items you want to protect and have at your immediate disposal if required. Some of those items include:

1. Advanced airway management
2. Special diagnostics
3. Pain-control meds (this is unit dependent)
4. Surgical instruments

What you decide to cross-load should be based on mission requirements, level of your teams’ medical training, medical director’s guidance, and local protocols. Every organization will have different requirements based on the above factors. It’s up to you to develop your plan.

Hypothermia: Is It a Valid Concern in a Hot Enviroment?

According to information published in the latest “Lessons Learned” from Iraq it is one of the most important variables concerning the survivability of casualties. Hypothermia, as our readers know, is one of the three components of the lethal triad–acidosis and coagulopathy being the other two. Even if it is hot outside, care must be taken to ensure casualties do not loose heat. Below you will find an abstract from an article that speaks to the importance of preventing hypothermia.

The impact of hypothermia on trauma care at the 31st combat support hospital.
The American Journal of Surgery, Volume 191, Issue 5, Pages 610-614
Z. Arthurs, D. Cuadrado, A. Beekley, K. Grathwohl, J. Perkins, R. Rush, J. Sebesta

Abstract

BACKGROUND: The primary objective of this study was to review the incidence of hypothermia, and its effect on surgical management, resource utilization, and survival at the 31st Combat Support Hospital (CSH). METHODS: This study was a retrospective analysis of all combat trauma injuries treated at the 31st CSH over a 12-month period. All trauma admissions were included. Descriptive and inferential analysis were performed using SPSS 11.0 software package (SPSS Inc., Chicago, IL). RESULTS: A cohort of 2848 patients was identified; 18% were hypothermic (temperature <36 degrees C). Hypothermia was significantly (P < .05) correlated with admission Glasgow Coma Scale (GCS), tachycardia, hypotension, lower hematocrit, and acidosis. Hypothermic patients had a significantly higher blood product and factor VIIa requirement. Hypothermia was an independent predictor of operative management of injuries, damage control laparotomy, factor VIIa use, and overall mortality (P < .05). CONCLUSION: Combat trauma patients have a high percentage of penetrating injuries with variable evacuation times. Hypothermia was a pre-hospital physiologic marker, and independent contributor to overall mortality. Prevention of hypothermia could reduce resource utilization and improve survival in the combat setting.