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Tactical EMS: Advancing from the front line

EMS itself was really born in war, and the very first ambulances were seen on the battlefield

There are two very different kinds of EMS: military and civilian.

EMS itself was really born in war, and the very first ambulances were seen on the battlefield. Walt Disney himself worked on an early ambulance in WWII. Modern tactical medicine builds on this legacy.

EMS advances during times of war. We make enormous medical strides during each period of armed conflict, and the last ten years are no exception. Most of these advancements are focused on what kills soldiers: trauma. Tactical EMS in the civilian world has already adopted many of the techniques and technologies proven to work on the battlefield. Bleeding control is one area where we have made numerous advancements and learned some valuable recent lessons.

AP Photo/Kevin RivoliSgt. Cory Surla works briskly to stabilize a wounded patient and ready him for evacuation at the Medical Simulation Training Center at Fort Drum, N.Y. 
AP Photo/Kevin RivoliSgt. Cory Surla works briskly to stabilize a wounded patient and ready him for evacuation at the Medical Simulation Training Center at Fort Drum, N.Y. 

Hemostatic dressings are those with special properties that speed coagulation and clot formation. There are several good ones available today. One of the first was Quick Clot, now we have HemCon, Celox, and ActCel to name only a few. Hemostatic dressings can reduce tourniquet time, which brings up a very old device recently becoming more popular again.

When direct pressure and hemostatics alone fail, another great way to stop bleeding is the old-fashioned tourniquet. We have learned more recently in Iraq and Afgahistan that they rarely cause limb loss as we once feared, and can save lives.

The easiest way to make a tourniquet is with a triangular bandage. Roll it long ways into a 1-2" wide band, encircle the limb and tie in a firm square knot. Then, find a windlass to tighten it. A stick or even an oxygen wrench will work fine. Slide the windlass under the bandage and twist until arterial blood flow to the distal extremity is occluded. Tape the windlass down into a secure position and document the time is was applied. It's really that simple.

For those who want a ready-to-use version, there are several good ones on the market.

The SOF Tactical Tourniquet features a black nylon-webbing strap, with an integrated windlass. There is a retainer to secure the windlass "stick" once correct pressure is achieved.

The MAT, or Mechanical Advantage Tourniquet, features a rotary dial; you twist an innovative windlass mechanism to apply tension. Both of these commercially available tourniquets come ready to use, and take up very little space.

When you are confronted by severe bleeding, the kind you can't control with direct pressure, they can prove to be indispensable. I strongly suggest you open and practice with once until you can use it in the dark. Remember, always mark the time of application and re-check distal pulses and the bleeding site periodically.

Tactical EMS has also adopted use of supraglottic rescue airways. are compact, light, fast, and effective. Examples include the King LTS-D, the LMA Supreme, and more recently the I-gel. One nice thing about the I-gel is that it does not need a syringe. This speeds application and reduces the number of parts. Once the patient can be extricated from the danger zone, more advanced devices can come into play. Tactical ventilators can sustain respiration but have to be able to run on a compressor.

The SAVe (Simplified Automated Ventilator) by AutoMedx is a highly portable, automated ventilator originally designed for use on the battlefield. The SAVe is sort of a portable suction machine that operates backwards. It’s driven by a small, portable battery-powered air pump that delivers a preset tidal volume and rate suitable for most adult resuscitation needs. It guarantees a more consistent volume of ventilation at controlled ventilation rates and pressures.

It delivers a fixed tidal volume of 640cc without supplemental oxygen 12 times per minute, at room air oxygen concentrations, with a reliable 38-40cm pressure relief and inherently safe 24LPM inspiratory flow. It eliminates complications from hyperventilation, while assuring a minimum minute volume at safe inspiratory pressures.

The comPAC from Pneupac is another compressor driven portable volume ventilator, only bigger and more advanced. It is built like a tank and everything about it is rugged. The comPAC will deliver volume, rate, and pressure-controlled ventilation under the most rigorous of field conditions. I don’t think it is available yet in the U.S., but it does have a NATO stock number.

Another great line of simple, straightforward ventilators are made by Allied Healthcare. The MCV100 is a battery powered weather resistant ventilator specifically designed to meet the unique demands of mass casualty incidents. This ventilator delivers ambient air or oxygen at a tidal volume range of 200 to 1200 ml, and ventilation cycles of between 8 and 20 breaths per minute. The MCV100 can be powered by its internal rechargeable battery or by standard 110 volt electricity.

Another way to approach the resuscitation challenge is the new Cyclone Pocket BVM. This fully functioning silicone BVM folds up and stores very compactly. It comes in a hard plastic twist open case.

These are just a few of the hot new Tactical EMS products now making their way into civilian EMS. For a lot more tactical products check out North American Rescue and Bound Tree Medicals Military Division, or Remote Medical.


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