TACTICAL MEDICINE:BEYOND TOURNIQUETS: HOW TACTICAL MEDICINE NEEDS TO EVOLVE
By Krisztian Zerkowitz When it comes to tactical medicine, and in general when we speak about medicinal care for non-medical personnel, the tourniquet has become the go-to piece of equipment.It is common to see Stop the Bleed classes, everyone carrying tourniquets and everyone becoming an expert on the subject.Let me clarify, I absolutely believe in the value of a tourniquet and think that taking a Stop the Bleed class, carrying tourniquets, etc. is important. This article is not about me complaining about the overuse of tourniquets for the sake of being 'tacticool'.Rather, it is about bringing to light the change in injury patterns and what first responders may be treating. As professional protectors and those in the security field, this is something that needs to be discussed.Everyone who knows me, is aware that I'm a big TCCC enthusiast, so I'm not going to criticize the MARCH protocol or all of the Care Under Fire, Tactical Field Care stages and how selfassessment and buddy aid can save lives. (By the way, if you are examining this, and it doesn't sound familiar, that's okay, but please get trained as it could save you or someone else's life eventually.)But, the entire TCCC protocol was established many years ago and it is founded on a study completed many years ago. And you know what, with the changes in security, assaults, degree of brutality, kind of violence and possible threats, not only tactics change, but medicine does as well. In addition to the developments in medical treatment options and the continuously changing gear, OUR PATIENTS HAVE TRANSFORMED. And when I say, patients have altered, I mean, the causes of death, the mechanisms of injury and the potential need for the type of treatment, have all changed.The medical protocol is being determined according to the rule that the most fatal injuries should be treated first, and a considerable emphasis is set on the M (Massive Bleeding). This is due to the fact that it is a simple skill to learn, tools for it are easily obtainable, and it is effortless to carry. However, in recent events, it appears that there has been a shift, although it is still essential to stop the hemorrhage, and massive bleedings are still lifethreatening if not addressed promptly, other traumas are becoming increasingly frequent and can be similarly hazardous.Injuries related to explosions, such as sucking chest wounds and tension pneumothorax are becoming more common due to the increasing use of Improvised Explosive Devices (IEDs) and vehicles in violent attacks. Even though there are ways to treat these respiratory issues in the field, it is not as straightforward as dealing with severe bleeding, though it is just as critical.“ Massive bleedings are still killers that, if not treated fast enough will make all your other skills obsolete.  Acquiring the relevant skills for tactical medicine demands additional training, equipment, and expertise. Also, what is legally permitted and the duration of time spent with a patient diverge. This is a difficult situation. So, what is the way forward? How can we adjust our training, skills, and resources to address this everchanging battlefield of medicine? This is an excellent question that has multiple answers. Some of these answers require adequate financial resources, while others require more backing and one that necessitates the collective contribution of all those involved in the industry. Let us take a closer look at this last one.As is the case with all aspects of our field, we must adapt and alter our methods and approaches in line with the changing times. We modify our instruction and lower the bar of the skills expected of practitioners, and try to come up with effective solutions. Has our modern, fast-paced lifestyle led to the need to rethink medical instruction and care? Is it necessary to teach a large number of people how to do a lot in the shortest time possible (like TCCC, which was designed to give everyone the essentials as quickly as feasible)? Or is it better to just modify existing protocols to suit our purposes, even if they don't fit perfectly? This is a difficult matter and while there may be existing programs that address the issues, the industry may benefit from its own standards and not ones borrowed from elsewhere.It is fair to say that no other industry has a tactical profile similar to executive protection, and its medical protocol is tailored to the specific needs of the industry. We are not soldiers, police officers, or first responders, but possess a unique blend of skills and resources that dictate a different approach and plan of action.It is without question that we must evaluate how we practice medicine and readiness outside of the ideal, but in line with the daily tasks we face. We must adjust the current medical approaches to fit our tools and assets, both in terms of technology and financials. We can borrow certain ideas, but what we can't do is rely on what is already established, expecting it to fit into our current needs. Otherwise, the patient and all involved will endure the repercussions.To put it simply, let's cease recycling the same methods, let go of that which is outdated and be bold enough to acknowledge that our industry merits its own specific medicine since it is a complex operating environment.Just my two cents.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.