The tactical field care phase of special operations forces (SOF) combat casualty care is distinguished from the care under fire phase by the increased time available to provide medical care and a reduced level of hazard from hostile fire. This term also applies to situations where an injury has occurred while conducting an operation, but the injury was not a result of hostile action. This phase of care is characterized by:
• A reduced risk of exposure to hostile fire (risk has not been completely eliminated).
• Medical equipment that has been carried into the field by the special operations medic and other special operations war fighters on infiltration.
• The highly variable time available for managing casualties (CAX). In many cases, tactical field care may consist of a cursory evaluation and rapid management of wounds, with the expectation of re-engagement of hostile fire at any time. In other cases, there may be ample time to perform a more thorough evaluation and to render whatever care is available in the field. Once the tactical situation is under control and/or CAX have been recovered and moved behind cover, the special operations medic should initiate triage (in the case of multiple CAX) and manage all CAX. In this phase of care, a more in-depth evaluation and management of CAX, reassessment of conditions and interventions previously performed, and a focused approach on the conditions not addressed during the care under fire phase may be initiated. However, management of CAX must still be dictated by the tactical situation at hand. Nonessential evaluation and management of CAX must be avoided during this time. Care must be rendered once the mission has reached an anticipated evacuation point, without pursuit, awaiting casualty evacuation (CASEVAC); however, the special operations medic should take great care to allocate his medical supplies and equipment in the event re-engagement of enemy action occurs or the evacuation is delayed. Place CAX in the coma position (recovery position), optimally with their head at the same level as their heart. If hypovolemic (hemorrhagic) shock is a possibility, elevate their feet 6-8 inches (modified Trendelenberg position).
Note: The special operations medic should not abandon the basic principles of body substance isolation while caring for CAX. Even under battlefield conditions, wear gloves (latex or vinyl) and protective glasses, as a minimum, not only to protect against contact with serological fluids, but also to keep your hands clean. Blood and fluids are slippery, and if you do not don gloves and your hands become bloody, it is difficult to clean them in the field. You will end up wiping your bloody hands on your uniform and cross-contaminating other CAX. Establish priorities Obtain situational awareness, contain the scene, and assess CAX. Form a general impression If no other war fighter was present at the time of the injury, briefly note any clues as to the mechanism of injury to develop an index of suspicion as to the underlying trauma and organ systems that may be involved, as the signs and symptoms may be subtle. For instance, the presence of hearing loss (possible tympanic membrane rupture) as a result of blast injury should alert the special operations medic to the possibility of blast injury to internal organs (gastrointestinal, lungs). Note the casualty’s body position, overall appearance, and any outward signs of distress. Begin rendering Medical Aid as per TCCC protocols.
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