Tactical situations in emergency situations
If there are wounded to be treated, you call the emergency services. The paramedics then take care of everything else. This is a principle that is firmly anchored in most of our minds. But what if the emergency services are unable to reach the injured because their own lives are at risk - for example during a shooting rampage? A case for TEM - tactical emergency medicine.
What is TEM?
Tactical emergency medicine combines emergency care for the wounded with tactical considerations based on military operations. TEM has long been standard practice there. Specifically, tactical emergency medicine always takes the current situation into account and checks whether it allows intervention without risking further casualties. Guidelines and phases have been developed to support emergency services in this decision, defining exactly what needs to be done in which situation.
What phases or zones are there for treating the wounded?
The military has developed a concept - Tactical Emergency Medical Support, or TEMS for short - that divides operational areas into different phases. Depending on which phase the battle is in, there are different instructions for the care of the wounded in an emergency. Outside of the military, however, a division into zones has proven its worth.
Specifically, there are the following three phases/zones:
- "Care under fire" phase or hot zone: This is where there is the greatest danger for the emergency services and the wounded themselves. For this reason, care for the injured in this area is minimised. Depending on the situation, this may also mean that the wounded person is instructed to look after themselves for the moment while the emergency services attempt to seek cover in a more secure area.
- "Tactical Field Care" phase or warm zone: This area has already been partially secured. For this reason, initial emergency medical care can now be given to the casualty. This is where the emergency services gain an initial impression of the patient, stop any critical bleeding and get an overview of the type and severity of the injuries. For a subsequent systematic examination, cABCDE/XABCDE or MARCH were developed, which will be discussed in more detail later.
- "Tactical Evacuation Care" phase or Cold Zone: During this phase, both the emergency services and the patient are away from immediate danger from the enemy. Emergency care can therefore now be given to the casualty. This phase often takes place while the casualty is being transported out of the danger zone.
The TEMS concept is based on the research project "Tactical Combat Casualty Care", or TCCC for short. It deals with the tactical care of combat casualties and originates from the U.S. Special Operations Command. Following the publication of the guidelines, which describe what should be done in which situation, a committee was set up to continuously review these guidelines and adapt them if necessary.
What is the procedure for TEM measures?
Studies have shown that trauma can often be attributed to specific injuries. For this reason, the so-called "cABCDE" and "MARCH" schemes have become established in the tactical care of the wounded, which systematically review the most probable causes of injury. The individual letters in the cABCDE scheme stand for the following terms/steps:
- c=Critical Bleeding/Stop Extreme Bleeding: This is the only action taken while still in the hot zone, if necessary, because severe bleeding was the cause of death in nearly two-thirds of all decedents who died during a military emergency. Injuries referred to here include amputations.
- A=Airways/clear airways: Blocked airways were the cause of around a third of all deaths in military emergencies. This aspect is therefore checked next. If the facial injury is so severe that free breathing cannot be ensured, a coniotomy, i.e. an opening of the airway above the larynx, must be performed.
- B=Treat breathing/chest injuries: Injuries that lead to a tension pneumothorax (accumulation of air continuously increases the pressure in the chest) are particularly dangerous. If this is the case, a decompression puncture must be performed promptly to equalise the pressure.
- C=Circulation/control of bleeding: Next, the patient's entire body is searched for further bleeding. Any injury found is bandaged or tamponaded if necessary to reduce blood loss.
- D=Disability/Deficits of the nervous system check: This includes checking the pupillary reflex. Neuronal deficits are checked if the patient reports them.
- E=Exposure/Supplementary measures: This includes, for example, keeping the patient warm. Protective blankets, which are also used in alpine regions, have proven their worth. They are small and easy to handle and generate heat quickly, usually by reacting with oxygen from the air.
The MARCH scheme is organised as follows:
- M=Massive bleeding/supply of massive bleeding
- A=Airway/respiratory tract
- R=Respiration/Breathing
- C=Circulation
- H=Hypothermia/subcooling
What are the aims of TEM?
In principle, tactical emergency medicine always aims to save lives. However, it keeps an eye on the current conditions and, in case of doubt, prioritises the protection of many over the care of individuals. During enemy fire, for example, no one is helped if their comrades rush to the aid of a wounded person but are themselves hit in the process. It is safer for everyone to retreat as quickly as possible and then, if the situation allows, to intensify medical care for the wounded.
Training in TEM measures has long been standard in the military, but civilian emergency services can also benefit enormously from special training in tactical emergency medicine. The aim is to enable police officers, firefighters, paramedics or other suitable personnel to act in a considered and targeted manner in a critical situation - for example during a terrorist attack or shooting spree. In this way, the care gap between evacuating the injured person from the danger zone and providing safe care in a secure area can be closed.
Nevertheless, it should be noted that the first measures to be taken are always the self-protection of the emergency services and the evacuation of the casualty from the danger zone - only then do medical measures follow. The phases or zones were developed for this reason. This relieves the individual of the difficult and psychologically stressful decision of whether to save themselves or their wounded comrade.
What is important in TEM training?
Tactical emergency medicine means acting strategically in an exceptional situation. To be optimally prepared for this, it is important that the training setting is as realistic as possible. To this end, life-threatening wounds are applied to the "wounded" with the appropriate accessories in an impressively realistic look. Regular repetition exercises are also part of the training so that the application of the acquired knowledge becomes routine.
Our range includes numerous medical products that are indispensable for tactical emergency medicine. These include tourniquets for stopping extreme bleeding and thermal protection products. We also offer you impressively realistic applications to simulate various injuries for the most effective training possible.
Do you need personalised product advice? No problem - please contact us directly. We will be happy to help you!
