Tactical Medicine (TC3): how we mastered it and what it really is

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

I was recently able to attend a TC3 (or TCCC - Tactical Combat Casualty Care) tactical medicine class. In a nutshell, TC3 is first aid in combat. According to statistics, about 60% all the wounded, more 33% deaths are due to breathing problems and chest bruises. A person can "flow out" in 2 minutes, so it is very important to be able to quickly apply a tourniquet and stop bleeding even under fire.

Practice shows that even a person who is well-versed in providing first aid is somehow quickly lost when explosions and shots are thundering around. Tactical medicine not only takes into account the extreme conditions in which first aid is provided, but also focuses on evacuation wounded from under the fire.

At the beginning of the training, I could only uncertainly apply a tourniquet and bandage, which my militarist friend had taught me the day before, so that I would not seem completely "green".

Before the course, I was uncomfortable. I do not like extreme situations when you need to make decisions quickly. I do not like it when they yell at me, and even a real weapon causes conflicting feelings of interest and fear in me. I was scared that I would not keep up, I would not grasp and I would screw up. Somewhere it was, but the reality still turned out to be more interesting.

At the beginning of the lesson, the instructors gathered all the participants - about a dozen people - and gave a short briefing. Every now and then, a shot from a neighboring landfill "flew in", so I had to immediately put on ballistic goggles.

Theoretical part

1. There are three types of zones for a paramedic on the battlefield: red (most dangerous), yellow (around the corner), green (safe).

The red zone is where they shoot directly. If the wounded person is in the red zone, they do not dress him, but they conduct an initial examination of the whole body for bullet wounds and apply tourniquets. This is followed by an evacuation to the yellow zone.

The yellow zone is the zone where no active clashes are taking place. Roughly speaking, this is the area "around the corner" or "behind cover". Here, a secondary examination of the wounded is carried out: the person is bandaged, the tourniquets are loosened, further transportation to the green zone is being prepared.

The green zone is where the evacuation of the wounded takes place and where the paramedic's area of responsibility ends - then doctors in field hospitals will deal with the wounded.

2. Regardless of where the wound is on the arm, the tourniquet is applied as high as possible. The same goes for leg injuries.

3. A tourniquet correctly applied to the arm causes palpable pain in the arm at the point of compression. A correctly applied tourniquet on a leg does not allow you to stand on that leg and also causes pain and discomfort.

4. In the red zone, only tourniquets are applied. Bandaging, blocked tongues, cleansing the respiratory canal and everything else - this is for the yellow zone. And even if it seems that it is possible not to apply a tourniquet, but to grab a wounded soldier and drag it over a mound or into a shelter, it is better to refuse this undertaking: at any moment a new enemy firing position may open up, which will "work" for you, and you will get stuck for an hour or two.

5. Bandages for dressing come in 4 "and 6". It is better to give preference to 6 "ones, because they, unlike 4" ones, allow you to bandage a severed limb, for example, a hand.

6. Any tourniquets are disposable. This applies to both rubber Soviet and modern Israeli and American.

7. Each fighter must have at least two bundles: one for myself, the second for a friend. When providing first aid to a wounded soldier, his personal harness is always used first. For this reason, in order to know where to look for a tourniquet from the comrade, it makes sense to unify the location of the first-aid kits and their contents for all platoon soldiers.

8. Before evacuating a soldier from the red zone, if he is unconscious, you should first take all firearms from him. There were cases when a shell-shocked soldier suddenly came to his senses and, not understanding the situation, began to shoot from the sides in a fever.

9. The armor must always remain on the fighter being evacuated. If the bulletproof vest has fallen off the soldier, it makes sense to put it on top of the soldier - this will give additional protection in case of stray bullets and shrapnel.

10. First aid for oneself with a neck injury is a hand clamping of an artery. Fortunately, the vessels leading to the head are duplicated, so a bandage can also be applied to the neck. But in order not to strangle oneself, the dressing must be done through the far arm.

11. The sequence of stopping bleeding is somewhat reminiscent of repairing a leaking pipe: tourniquet (block off the blood) → dressing (close up the hole) → release the tourniquet (if blood is no longer flowing).

In the beginning, we learned to put tourniquets on our hands and feet in calm "academic" conditions. By the way, today the best tourniquets, bandages and other means for providing first aid on the battlefield are produced in Israel and the United States. The advantage of modern tourniquets is that they can be applied with one hand, that is, for example, by yourself.

In open form

In open form

Modern tourniquet folded

Modern tourniquet folded

After a short introductory theoretical and practical part with the imposition of tourniquets and dressings, we began to carry out all these manipulations while lying down and at speed. After that, the instructors threw several "wounded" under the car, and threw a smoke bomb nearby: we trained to examine the victims and provide them with first aid in cramped conditions with limited visibility. The sensation is not pleasant when the acrid smoke blocks the eyes and chokes, burning the throat and nostrils.

Then we learned to carry out the evacuation - both with bare hands and with the help of special means such as folding or frame stretchers, as well as braids with a carabiner and rope. Even then, each of us felt how difficult it was to pull a person in full gear alone at least 20 meters away. In addition to single methods of evacuation, we practiced evacuation together, three, four. And even when there are four of you, a stretcher with a 100-kilogram fighter is very difficult.

Exam

The most "delicious" was saved at last. We were divided into two groups of six people each, and I turned out to be the commander of one of them (which I frankly did not want). Our task was to promptly respond to the changing picture of a conditional battle and practice everything that we learned during the training.

We moved in two groups outside the green zone, and then it began: explosions of grenades (with plastic bullets that flew in all directions, for greater realism), smoke bombs, screams, blood (food coloring + syrup). At some point, instructors ran up, poured blood on someone, and the situation changed completely: it was necessary to examine the wounded, provide them with first aid and evacuate.

At first there was a lot of crap: for example, we were able to evacuate our heaviest fighter only on the third attempt - the previous two attempts to thread the straps under him for lifting were not crowned with anything. The defense and cover of the group was not set up. Constant explosions of noise grenades made it difficult to concentrate, every now and then the ears were blocked. I was frankly not in the subject of how to organize cover and evacuation, therefore, in fact, our most experienced fighter was in charge of saving our squad.

Distance in 600 meters (back and forth) on bumpy roads and around obstacles took 1 hour 43 minutes (!), or 6 meters per minute. For the first time I tried to run in full gear - with an 8-kilogram body armor, a 1.5-kilogram helmet and a 3.5-kilogram machine gun. I must say that this is a really hellish occupation, especially if you need to drag a stretcher or a wounded man, and even run, and this is without the weight of the ammunition and without the real expense of nerves in a combat situation.

After the first hour, when we got to the transshipment area and began to conduct a routine examination of the wounded, it took me great efforts to spit out the saliva thickened from dehydration. It is at such moments that you begin to at least remotely understand the words of a soldier of one of the brigades, which managed to escape from the encirclement: "For the last three days we have had neither food nor water."

As for physical fitness, for me a real discovery was that not only running are united, but deadlift is our everything. After an hour of vigorous action in the evacuation zone, it becomes difficult even to keep the machine straight in the line of fire. And the constant lifting and lowering of the wounded is so exhausting that any lifting of the weapon from the ground or pulling the wounded from the stretcher to the ground turns into a serious test for the back muscles. So, I feel like running and deadlift is a must-have for any fighter.

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