Tactical Combat Casualty Care

"It was undeniable that we were saving lives with the use of tourniquets."
"If you keep the blood in [the injured person's body], then the patient survived. It was a complete change in thinking [use of tourniquets]."
"The first priority [for military medics as with paramedics] was making sure that no one else got hurt [making swift interventions critical]."
Lt. Col. Colleen Forestier, physician, director of health services operations, Canadian Armed Forces

"We are always prepared. We know that these environments [dangerous or distracting landscapes detracting the paramedic from fully focusing on the patient] exist."
"Is there more stress [for the responding paramedic, trained to assess situations through 'stress inoculation training']? I don't think it's any worse, except for the volume."
Greg Forsyth, superintendent of special operations, Ottawa Paramedic Service

This discovery of a simple enough technique long in use as an effective method whereby a deep wound could be stopped by use of a tourniquet from spilling enough life-blood to sap existence, from a critical wound, turned around the spurning of tourniquets to a recognition of their indispensable status as a life-saver under battlefield conditions. Trauma treatment that recognized the utility of tourniquets among other procedures came out of observations during combat in the Vietnam War.

Those observations led to the creation of a new protocol named TCCC, Tactical Combat Casualty Care, introduced for U.S. Special Operations Forces. The protocol was designed by physicians who reviewed battlefield casualties and avoidable deaths in the recognition that utilitarian measures that would never be considered in a hospital setting had their function in a battlefield setting. A deeply penetrating review of medical response on the battlefield brought about a new blueprint for a battlefield-casualty protocol, to save lives.

That protocol has now been adopted in urban areas where paramedics are called upon to respond to medical emergencies. Toronto introduced the first such tactical paramedic unit in Canada, in 1996, followed by Ottawa, in 2003. At the present time, similar units work out of every major city in Canada. Since Ottawa's first responders are called upon for response to federal government and embassies in medical emergencies where a myriad of risks could arise, work with the military, with police and the RCMP exist as additional options.

Canada's elite military special forces -- dispatched to respond internationally when high-risk situations arise requiring an expertly trained force deployed in extraordinary venues -- adopted TCCC in 1999. Since then the protocol has been adopted for more conventional, non-military responses in the recognition that just as battlefield wounds in the extremities were recognized as the leading cause of bleeding to death, that realization extended to the outcome of peacetime critical accidents or violent attacks.

On the battlefield, as on an urban highway or  through a criminal act, the use of tourniquets stopping morbid hemorrhaging was vital to maintaining life, and as such was prioritized as first-response treatment. Tourniquets now make their presence on all ambulances, as well as being carried by tactical paramedics. Gauze impregnated with blood coagulation agents and intraosseous IV (injecting drugs or fluid into the bone marrow) represent additional new rapid response aids.

These especially highly-tuned tactical paramedics must be prepared to face extraordinary situations, bringing their training and personal protective equipment into play. Where high levels of threat exist, as represented by their presence at an active crime scene or where unstable situations prevail, the tactical paramedics are skilled in appropriate response, including following the command of police partners and knowing how to proceed with direct and indirect threats complicating situations.

Tactical paramedics wear a 25-pound ballistic vest. They carry with them over 50 pounds of additional equipment, including collapsible stretchers, infuser for IV fluids, surgical tool kits, bleeding/hypothermia kits, hemorrhage and respiration kits, dressings, first aid kits and various other complex medical-response baggage to ensure they are fully capable of responding to a variety of emergency situations.

They must be extremely physically fit, aside from being well-trained and capable of responding under extremely stressful situations. This is obviously no career for the faint of heart. These professional first-responders learn to instantly form an action plan and use their expert qualifications as medics to treat for critical injuries and prepare patients for transport to hospital. Lives hang in the balance.