Phases of Tactical Medicine

The Care Under Fire Phase (Part 2)–Considerations

The Care Under Fire (CUF) phase of treatment requires a basic management plan. The plan is comprised of basic steps. Remember, it is the basics that save lives. They are as follows:

1) Regain your situational awareness.

  1. What type of threat have you encountered? An IED?
  2. What direction is the threat coming from? Will a secondary explosion/engagement occur? Is it occurring now?

  3. Are there any casualties? Am I a casualty?
  4. What do I do now? Treat the casualty? Return Fire?

2) Return Fire and/or take cover.

  1. Because this is the CUF Phase, which means you are still under fire, you are not a medic until fire superiority has been established. As the old saying goes, “fire superiority is the best medicine.”

3) Direct casualty, if applicable, to remain engaged in the fight.

  1. This may prevent the casualty from sustaining further injuries. This must be practiced in training. As Bruce Siddle has noted in Sharpening the Warrior’s Edge, practicing to play the casualty by quitting when shot during training will hinder one’s ability to do otherwise in real-world situations (i.e., do not get in the mindset that an injury precludes you from continuing to fight.

4) If patient is unable to continue to fight, direct him/her to move to cover and/or apply self-aid.

  1. This must be done in training. Get your operators out of the mindset that “doc will do medicine.” You must train them to provided self-aid, then buddy-aid, then, when applicable, expect medic-aid. The casualty is a casualty for a reason: The point of injury is dangerous, underfire, etc. Direct him to treat himself via yelling, radio, etc. Remember, however, that ears will be ringing post-explosion.

5) Prevent patient from sustaining additional wounds (SEE 3 and 4).

  1. In addition to 3 and 4, rescue ought to be considered. Practice tactical rescues in training. Train assaulters to quickly assess casualties during the tactical rescue. For example, if the casualty is talking, then airway is good. If responsive, ask where they are hit. Look for hemorrhage. Are they complaining about difficulty breathing? These are just a few examples.

6) Stop Catastrophic-Hemorrhage. (self-aid, buddy-aid, medic-aid)

  1. Use tourniquets where applicable.
  2. Hemostatic agents with pressure dressing if tactically feasible.

7) Airway management ought to be deferred until the Tactical Field Care phase.

  1. Not always possible. Be prepared to provide a surgical airway. If an airway compromise is sever enough to need attention during the CUF phase, then 99% of the time it will require a Cric. Do you have a Cric-Kit accessible? If it is in your bag, then it is not going to do the casualty much good. You need to have one in a mag-pouch, leg-bag, etc.

The above is a loose guide. Do not limit yourself to algorithmic medicine.

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