Tactical Emergency Care

TACTICAL EMERGENCY CARE:
MILITARY AND OPERATIONAL OUT-OF-HOSPITAL MEDICINE
by Robert A. De Lorenzo, Robert S. Porter

“Tactical Emergency Care explores the area of tactical emergency medical
services.
Focuses on the problems facing tactical EMTs and covers wounds from
conventional
weapons as well as nuclear, biological, and chemical weapons. For EMTs,
paramedics and
other first responders.”

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“Tactical Emergency Care explores the new and rapidly developing area of tactical
EMS.
Tactical emergency services is a special blend of prehospital care and
military-style tactical
operations, encompassing field and wilderness medicine under austere and often
hostile
conditions. Focusing on the unique problems facing all tactical EMTs, the text
covers
wounds from conventional weapons as well as nuclear, biological, and chemical
weapons.
Medical evacuation, environmental medicine, and triage as well as ambulatory care
and
topics unique to EMTs providing law enforcement medical support are also
addressed.

“Tactical Emergency Care is the number-one reference for Army medics, Navy
corpsmen,
and Air Force medical technicians. Law-enforcement officers and SWAT teams will
find the
focused, no-nonsense approach to field problems refreshing. Military and
paramilitary
physicians, PAs, nurses, and special-operations teams will appreciate the
sophisticated and
practical medical approach to the situations unique to their environment. Tactical
Emergency
Care is also an excellent reference for first responders, EMTs, paramedics, or
other medical
providers who wish to expand their knowledge of tactical EMS.”

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KEY BENEFIT

“This book explores the new and rapidly developing area of tactical EMS, a special
blend of
prehospital care and military-style tactical operations encompassing field and
wilderness
medicine under austere and often hostile conditions. This is the first commercial
book to
focus on military medicine at the EMT/military medic level. Key Topics: Focusing
on the
unique prehospital problems facing tactical EMT's, the book covers wounds from
conventional
weapons as well as nuclear biologic, and chemical weapons. Medical evacuation,
environmental medicine and triage as well as ambulatory care and topics unique to
EMT's
providing law enforcement medical support are also addressed.”

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FEATURES

- Addresses the rapidly developing area of tactical EMS.
- Focuses on military medicine at the military medic and advanced EMT
level.
- Highlights the terrorist threat of weapons of mass destruction, including
nerve
gas,
biological weapons, and nuclear bombs.
- Examines how a prehospital provider might perform primary ambulatory
care in
the
tactical environment.
- Includes objectives and summaries for each chapter, as well as illustrative
cases
and margin notes to highlight important points.
- Well-illustrated to provide a comprehensive look at the unique military and
law-enforcement tactical environment.

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TABLE OF CONTENTS

Preface
1 The Tactical Environment of Care
2 Injury Mechanisms from Conventional Weapons
3 Care of Ballistic and Missile Casualties
4 Care of Blast and Burn Casualties
5 Care of Chemical Casualties
6 Care of Biologic Casualties
7 Care of Nuclear Casualties
8 Tactical Evacuation
9 Evacuation Care
10 Tactical Triage
11 Tactical Environmental and Preventive Medicine
12 Basics of Tactical Ambulatory Care
13 Tactical Law Enforcement Medical Support
Appendix A Medications for the Tactical Environment
Appendix B Chemical Agent Protective Measures
Appendix C Fluid and Medication Procedures
Appendix D Advanced Airway Procedures
Appendix E Manual Carry and Lift Procedures
Glossary
Abbreviations
Index

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EXCERPT FROM THE PREFACE

“This textbook was borne out of a need for a professionally written emergency care
text
dealing with tactical medicine issues. It is designed to complement existing and
successful
emergency care teaching textbooks. This text builds on the strong foundation of
recognized
emergency care principles and practices. It is not intended to replace these
principles but
rather build on them. As such, the goal of this book is to present the principles of
tactical
emergency care against the backdrop of the nationally recognized curriculums and
standards
for emergency care and prehospital education. In that vein, we have strived to
present as
much new or reworked material as possible, drawing from the very best medical
and military
sources available.

“The intended audience is students and practitioners of emergency care in the
tactical
environment, including Army combat medics, Navy and Coast Guard corpsmen,
Air Force
medical technicians, and civilian EMTs and paramedics supporting tactical law
enforcement
and SWAT teams and paramilitary forces. Special operations medics,
independent-duty
corpsman and technicians, physicians, physician assistants, and nurses will also
appreciate
the state-of-the-art tactical medical approach. Disaster medical workers will find
the
principles of this text valuable in their work, particularly in light of the austere
conditions
faced in many disasters. EMS providers, including first responders, EMTs, and
paramedics
wishing to expand their knowledge or with an interest in preparing for situations not
covered
in traditional EMS textbooks, will find this volume particularly helpful. Hazardous
materials
experts will especially appreciate the detailed coverage of self-protection and
decontamination of nuclear, biologic, and chemical agents.

“Because this textbook appeals to a wide variety of prehospital providers, both in
and out of
the military, police, and tactical units, we have adopted the generic term medic to
describe
the tactical field provider. The time-honored title of medic is borrowed from military
usage
and
dates back at least to World War II, when it referred to enlisted (and sometimes
officer)
medical personnel. For this textbook, the medic may be trained at various levels,
including
basic or advanced life support. Nonetheless, to maintain unity, we will usually use
the term
medic to describe all the various tactical providers, unless specifically stated
otherwise.
Certainly, all providers are expected to operate at their level of training and within
their
system of medical control.

“Where possible, this book focuses on the primary standard of care found in the
tactical
environment. As such, this textbook encompasses a broad mix of basic and
advanced life
support techniques and strategies, and even introduces some new (to the
traditional
out-of-hospital arena) approaches. The textbook assumes the reader is well
grounded in the
principles of basic emergency medical technology practice. Airway, breathing, and
bleeding
control are emphasized along with rapid removal from the hostile environment.
Penetrating
trauma is a big part of tactical medicine and receives emphasis.

“Trauma is by no means the only component of tactical field care, however. Care of
nuclear,
biologic, and chemical casualties is now a great concern, as is preventive care and
environmental medicine. A new concept in civilian EMS (but a tradition in the
military) is the
out-of-hospital practice of providing ambulatory care for minor field problems, such
as
headache and sore throat. A chapter is devoted to this new concept, using the
successful
military model as a springboard. A chapter is also devoted to the emerging field of
tactical
law enforcement medical support, or tactical EMS.

“The emerging threat of terrorist attack using weapons of mass destruction,
including
biologic
agents, nuclear weapons, incendiary devices, chemical agents, and explosives
(the
so-called
BNICE threats) is covered in detail. All domestic providers from civilian rescuers to
National
Guard service members need to be familiar with this material. Finally, several
appendices
outline specific and useful information on field drugs, tactical airway management
and fluid
administration, manual carries, and protection against nuclear, chemical and
biologic
threats.

“It is our goal to provide the first textbook on tactical emergency care. We have
relied on the
best sources of information from all three military services, law enforcement
medical support
organizations, and others with an interest in tactical care. A thorough review of the
literature
supports the recommendations and guidelines in the text. Readers desiring this
information
are directed to the reading list at the end of each chapter. In some cases, our
advice goes
beyond what any one military service or agency uses as established doctrine. This
was
necessary to provide a single recommendation that was usable in most, if not all,
services
and circumstances. In all cases, however, the tactical medical recommendation is
based on
sound medical principles and represents the very best in patient care.”
- R.A.D. & R.S.P.

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ABOUT THE AUTHORS

ROBERT A. DE LORENZO, MD, FACEP

Major, Medical Corps, Flight Surgeon, US Army Ft. Sam Houston, Texas
Clinical Associate Professor of Military and Emergency Medicine Uniformed
Services
University of the Health Sciences Bethesda, Maryland

“Robert De Lorenzo is a major in the US Army on active duty. He has over 18
years
experience in traditional EMS settings, including basic EMT, paramedic, training
officer, and
medical director. He is also expert in military medicine and specializes in tactical
emergency
medicine. He is author of numerous EMS and military articles in the medical
peer-review and
EMS literature.”

ROBERT S. PORTER, MA, EMT-P

Senior Advanced Life Support Educator, Madison County EMS Hamilton, NY
Flight Paramedic, AirOne, Onondaga County Sheriff Department Syracuse, NY

“Bob Porter is the Senior Advanced Life Support Educator for Madison County,
New York,
and a flight paramedic with AirOne, of the Onondaga County Sheriff's ' Department.
He is
coauthor of the successful Brady series of EMS textbooks including Paramedic
Emergency
Care and Intermediate Emergency Care. He has over 25 years of EMS education
and
administrative experience and is considered a national leader in EMS education.”

CONTRIBUTING AUTHOR JOSHUA S. VAYER, BA, CSA
Director, Casualty Care Research Center &
Research Assistant Professor of Military and Emergency Medicine Uniformed
Services
University of the Health Sciences
Bethesda, Maryland

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1999, 384 pages. Order #DR621.
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