The core tenants of Care Under Fire boil down to this: Keep as many men on as many guns as possible for as long as possible. Care under fire is quick and dirty, there is no time for bedside manner. Vitals? Get out of here. Perform a quick assessment and try to stop anything that will cause the patient to die in the next few hours and keep firing. See a bleed but not sure just how bad it is? Tourniquet that extremity. I know that tourniquet is a bad word in the civilian field and it’s because civilian EMT’s and Paramedics have the luxury of doing their job without someone trying to murder them and their patient while they provide care. The best medicine for the rest of the team who hasn’t been hit is to make sure the enemy is no longer a threat, and the most effective way to do that is by large volumes of fire. Neutralize or suppress the threat at hand and then go to work, no room for any medal-of-honor-type heroics here of running through a firefight to get to a wounded man; you are no good to your team if you’re a casualty as well. It’s a hard pill to swallow, but so is war. Ideally, every man in the fight knows something about something medical and can slap a tourniquet on an injury and make sure the guy is breathing before you begin your assessment, which makes life easier for you as the person treating the patient. It’s important to keep in mind the tenant of care under fire. If you are in a fight your only goal as a medic is to keep people firing downrange. Your first goal is stopping the bleed, airway is secondary (I can hear the civilian EMS people gasping at that blasphemy). A person can bleed out in 60 seconds but can go 3-4 minutes without air before damage occurs. If you happen to be standing right next to someone who gets hit, drag him to cover and slap a tourniquet on the extremity and keep firing. Losing blood is going to kill you well before lack of oxygen. A good flow chart to remember when faced with a fight is this: Self Aid, Buddy Aid, Medic Aid (Corpsman Aid). If you get hit but you are not down, take steps to do what you can for yourself then call a buddy and he will use your IFAK to keep you good and finally call the medic. In a perfect world the medic doesn’t get involved until the fight is over but we don’t live in a perfect world. Remember MARCH when assessing a casualty. It’s an acronym used in the military, because we love acronyms. MARCH stands for: Massive hemorrhaging, Airway, Respiration, Circulation and Hypothermia. Its the list of the 5 most prominent battlefield killers. Ensure your patient isn’t bleeding profusely, has an open airway and is actually using it and isn’t about to freeze to death. Just remember that if bullets are flying at you, its not a good time to bag someone or start CPR. You can apply these tenants just about anywhere – from a WROL situation to an accident at the range. If you are dealing with something that can kill you and can do it quickly, it is a good idea to have an IFAK on your person and have everyone involved with the activity know how to use it. An IFAK is an Individual First Aid Kit, (or “improved” first aid kit if you suffer from an affliction known as being in the Army). Another one of those acronyms we love so much. The idea is that if you get hurt somehow, the other person with you is going to dig into your IFAK and treat you with it, treatment being limited to just making sure that person is not about to die of his injury while you await EMS. Obviously in a WROL situation this is different and you don’t have to worry about all the legal implications of treating someone. It is important to use the casualties’ IFAK and not your own because yours will be used should you become a casualty as well. A first aid kit like this should be built around the activity you are doing but basic components should include at least: Two tourniquets Two occlusive dressings Trauma scissors Some gloves Alcohol wipes Bandages 2×2 gauze Pressure dressings The main goal is to stop the bleeding and make sure the patient is breathing and that they won’t die before a higher echelon of care is reached. Another thing to consider is that each IFAK should be uniform to every other member of the team, this way with all the adrenaline and stress that a trauma situation entails, let alone a trauma situation under fire can bring to bear, it is easier to provide treatment and reduces confusion because everybody knows the ins and outs of each others kit. Uniformity is not just something drilled into us by the military for the purpose of being anal, it is something that can save lives under dire circumstances. Take the time to train now while nothing is happening, get familiar with your kit or take this time to build a kit if you don’t have one. Attend classes, reach out to knowledgeable people in your network, read Forward Observer and attain the necessary knowledge required to survive. It’s never too late to start being prepared – unless the shit has already hit the fan, then it is too late. Continue reading...
I use a modified version, being more accustomed to the routine: BBC (bleeding, breathing, condition). Exactly.
