TACTICAL MEDICINE

ADVANCED FIRST AID? OR SOMETHING MORE?

In recent times, more and more people are talking about tactical medicine and naturally, we all have our own opinions on the subject, as we’re entitled to!

By Krisztian Zerkowitz

And, while I’m sure, there are some reading this who are more experienced than I am on this topic, so bear with me. But, from the extent of the experience that I bring to the table and from what I see happening around me, I feel strongly that this is an important topic to discuss. From what I can tell, it seems that some people view ‘tactical medicine’ simply as another tool in your first aid belt kit, and another new box to be ticked.

Medicine in the protective industry, has always had its role. Going back to the earliest days of protection, be it in war or wealth, people that went out to fight or potentially be fought against, had some sort of knowledge about medicine. Today, most licensing bodies require some sort of medical training within the curriculum of close protection. So, yes, medicine is a part of protective operations, the less popular little sister, because how much more fun it is to train vehicle operations, “pew-pew” scenarios or complex attacks? But ok, there is a place for medicine.

I have been doing tactical medicine years before the now long ago, but still fresh, terrorist attacks in Western Europe, including Brussels, Paris, Barcelona, and Nice, just to name a few. Actually, writing this, I just had a quick look to one of my first TCCC (Tactical Combat Casualty Care) courses, which was in July 2009. When doing the course at that time, it was something that seemed revolutionary and a little bit “over the top” for the private sector. But, I believed in it and saw why this would become important. Today, TCCC, TECC and whatever you want to call it, everyone is doing it and a tourniquet is a tool that everyone is carrying.

Like with everything that becomes popular, more and more people start doing it and more and more people start adapting the principles. How do you know something is popular? How many providers can you find for it? Well, for tactical medicine, you can find MANY these days. But then I start to wonder, who is teaching what? And where did all these specialists come from, all of a sudden? So, a quick search will show that, even if they don’t call it “tactical” there are many providers offering courses that are C-TECC educational content approved, or “as per TCCC recommendations” etc. And yes, the medicine, is all the same. Most people use the well-known MARCH protocol, talk about the IMPORTANCE of Massive Bleedings and the tourniquets and the chest seals and the pressure bandage… And they provide these trainings in the course of a day, 8 hours, which actually is even less than an obligatory first aid at work course in some countries.

Now again, don’t get me wrong, YES, something is better than nothing, understood, but then what I am on about and why this personal rant about tactical medicine?

Well, if you look at the abbreviation used and the “protocols” everyone adheres to, we see that they all start with the “T” (Tactical). But tactical has a lot of meanings. If we look it up in the dictionary:

adjective 1.

relating to or constituting actions carefully planned to gain a specific military end.

“ Actions that you take to achieve a goal that is beyond the immediate action, either through good planning or careful and rehearsed direct action that results in the best possible scenario to save life and limb ”

“ "as a tactical officer in the field he had no equal" ”

2. showing adroit planning; aiming at an end beyond the immediate action.

“ "in a tactical retreat, she moved into a hotel with her daughters" ”

If I translate this roughly into today’s setting and into something that fits this train of thought, tactical for me translates into:

“Actions that you take to achieve a goal that is beyond the immediate action, either through good planning or careful and rehearsed direct action that results in the best possible scenario to save life and limb.”

Now, tactics are extremely hard to teach, hard to implement, and hard to use. They are always up for debate, and it is a topic that does not provide one answer to each situation. There are more ways to skin a cat as we say here. So, in tactical medicine, the hardest part is the whole tactical aspect, the approach, the how do we stay alive while keeping those alive that have NOT managed to apply the right tactic. You can see how tough this is…

When we look at the medicine in tactical medicine, this was designed to translate to the language of every common soldier and everyone should be able to implement it, easy, fast and lifesaving medical skills that would fit in the scope of practice of anyone. (This was the base idea when TCCC came to life…). So, the medicine is easy to teach, easy to assimilate and easy to learn.

Putting the medicine and the tactics together, becomes your TCCC or TECC course, which now, all of a sudden requires a much more comprehensive approach to teaching, to understanding the role of the provider you are teaching and understanding the threat faced by someone you are teaching to deal with GSWs (Gun Shot Wounds) and blast related injuries. Because let’s face it, if you are worried about these type of injuries and the treatment of them, you are in the field of something dangerous… Same as not wearing ballistic protection, but working armed. If you work armed, you are expecting to get shot at!

Today, people that have NEVER had to implement any type of tactics (military, civilian, doesn’t matter) have turned into TECC, TCCC or given any other name, tactical medical instructors (even the Stop the Bleed training). Yes, we need to teach as MANY people as possible how to stop a bleeding, but isn’t it our responsibility to teach people, who we are saying that they have only 180 seconds AFTER impact of a bullet, IF a massive bleeding starts, how and when they should approach such casualties? As an example, we can look at the Las Vegas shootings. Many people were killed while attempting to stop bleedings on others, because they failed to recognize the tactical situation and put themselves in danger.

So, when today the garden variety first aid instructor (which by the way is an extremely valuable skill and EVERYONE should be basic first aid trained), starts teaching the MARCH protocol, C-TECC approved, adhering the TCCC guidelines, there is a problem. Especially, when this instructor starts teaching law enforcement, security or in this case, CP/EP teams. Yes, they will get the medical and have an enhanced first aid skillset. But this is NOT tactical medicine and people should NOT believe they are ready to treat the casualties in tactical situations. Unless someone explains the importance of and how to differentiate between having 180 seconds to stop a bleeding, dealing with the threat, extracting, finding/creating cover, setting up gear, and being able to do all this under the most extreme stress levels, you are not training for what tactical medicine was meant to be.

“ Within special forces training, the most difficult thing to simulate, is fear of death. ”

You are training for the principal who suffers a traumatic injury in the comfort of his home and you can work your MARCH magic. But in this case, there are much better courses than this “enhanced basic first aid…”

Within special forces training, the most difficult thing to simulate is fear of death. Now imagine you’re making life or death decisions for yourself and your patient, while you are at stress level: “fear of death.” It will depend on your tactics and how you apply that medicine within the scope of those tactics. It is TACTICAL medicine, NOT enhanced first aid. Don’t forget that and don’t underestimate the importance of training the topic you wish to become proficient in… it’s not just a name, it’s a profession!

Krisztian was raised as a Diplomatic Close Protection Officer, working mainly for diplomatic missions, including assignments to the Middle East and Africa. Recently certified as a Tactical Paramedic, Krisztian spent the last 10 years of his protective career specialising in tactical medicine in high-risk environments and close protection. Two passions combined where enough remains to learn and experience.

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