German Version

 

Tactical Medicine and Tactical Casualty Care: History, Development, Principles, and Areas of Application

Florent Josse^{a, b}

^a Bundeswehr Hospital Ulm – Department of Anesthesiology, Intensive Care, Emergency Care, and Pain Treatment

^b Tactical Medicine Working Group of the German Society for Military Medicine and Military Pharmacy, Bonn

Summary

Tactical medicine and tactical combat casualty care are crucial parts of modern emergency medicine. They evolved from military experiences and are now applied in numerous civilian and law enforcement operations. This article outlines the historical development, necessity, and concepts of Tactical Combat Casualty Care (TCCC) and Prolonged Field Care (PFC), as well as various application areas.

The core principles of tactical medicine integrate medical care with the tactical situation. The tactical environment dictates medical actions. Different operational phases, from “Care under Fire” to evacuation, define specific algorithms for life-saving measures. TCCC has gained international acceptance and has been adapted by civilian guidelines.

Tactical medicine is increasingly significant in law enforcement, during terrorist attacks, natural disasters, in austere environments, in maritime or alpine scenarios. The war in Ukraine vividly demonstrates that tactical medicine is militarily and societally relevant. New technological and organizational developments are shaping the future of tactical casualty care. The goal is to provide robust, flexible, and situation-adapted care to protect casualties and caregivers.

Keywords: Tactical Medicine, TCCC, Casualty Care, Prolonged Field Care, LeBEL

Introduction and Background

Tactical combat care is an essential area of emergency medicine, particularly crucial for soldiers, police forces, and rescue services in threat scenarios. It ensures that casualties can be treated even under extreme conditions with limited resources, based on algorithms, and the tactical situation, without endangering the mission and other comrades through medical actions. The special challenge lies in uniting medical care with tactical requirements – whether on the battlefield, during police operations, or in civilian disaster scenarios.

Modern tactical medicine has evolved from military experiences. It has drastically changed over the centuries – from primitive aid methods on the battlefield to highly modern medical rescue chains. The key takeaway is clear: Time, technology, and tactics save lives. The concept of Tactical Combat Casualty Care (TCCC), in particular, has revolutionized pre-hospital trauma and casualty care and is now used not only in the military but also in police operations in civilian threat scenarios, albeit slightly modified [3][4][16]. This article summarizes existing insights and aims to provide foundations for the further development of this specialized medicine in the medical service.

History of Tactical Casualty Care

Early Modern Period – 17th to 18th Century

With the emergence of modern armies, the first organized structures for the care of wounded soldiers began. The Frenchman Dominique Jean Larrey (1766–1842),who served as a military doctor under Napoleon, is considered a pioneer in this area. In the 18th century, he developed the concept of the „flying ambulance“ (Ambulance Volante), an early form of casualty transport using horse-drawn wagons. This was the first step toward systematic and rapid medical service directly at the front [40].

Beginnings in the 19th Century

In the following centuries, it was recognized that the care of the wounded on the battlefield had to be systematized and improved. Another pioneer in this field was Friedrich von Esmarch (1823–1908), a German military doctor who developed, among other things, the triangular bandage and the bandage package. His book „Der erste Verband auf dem Schlachtfelde“ (1870) laid the foundation for modern self and buddy aid [39][44].

The idea that the wounded should be transported to secure zones as quickly as possible became a strategic principle in care in the 19th century. During the American Civil War (1861–1865), a systematic evacuation system was established using horse-drawn wagons, bringing injured soldiers from the combat zone to field hospitals near the front. The goal was to avoid dreaded infections through timely wound care [13].

Advancements in World War I and II

In World War I (1914–1918), motorized ambulances were used for the first time, allowing faster transport, although existing trenches made care difficult. In this context, the first systematic evacuation routes (e.g., medical vehicles, horse-drawn carts) emerged. Detailed textbooks explained the infrastructure of casualty care, from front-line dressing and collection points to barracks camps in the rear and transport trains to homeland hospitals. In Germany, the first specialized clinics for trauma and rehabilitation were established [30].

In World War II (1939–1945), the priority of stopping bleeding and the rapid transport of casualties were especially established [12]. During the battles in North Africa, British and American doctors recognized that the rapid evacuation of casualties by airplanes significantly improved survival rates. This was the precursor to the modern MEDEVAC system [14].

Vietnam War and the Introduction of Air Rescue Systems

The Vietnam War (1955–1975) was one of the first conflicts where helicopters were systematically used for medical evacuation. During this time, the term „Golden Hour“ emerged, coined by Dr. R. Adams Cowley, a surgeon and military doctor in the USA, in the 1970s. Experiences from the Vietnam War showed that patients who reached a surgical center within an hour after trauma survived significantly more often. The „Golden Hour“ refers to the first time window of about 60 minutes after severe trauma, where adequate medical care is crucial for the patient‘s survival and prognosis. The goal is to avoid the „Second Hit“ in terms of further systemic damage due to delayed care [10][21][25]. The combination of rapid evacuation and early surgical interventions in mobile surgical units revolutionized war surgery [16][26].

The Turning Point: Mogadishu 1993 and the Introduction of TCCC

A turning point for tactical casualty care was the Battle of Mogadishu (1993), where 18 US soldiers died because civilian trauma care standards like Advanced Trauma Life Support (ATLS) did not work under combat conditions [35]. These painful events had a formative influence on the development of modern military emergency medicine, particularly on the introduction of the Tactical Combat Casualty Care (TCCC) concept [22].

Based on the experiences from Mogadishu and with the aim of developing an algorithm-based and military-situation-adapted trauma care, Butler et al. first published „Tactical Combat Casualty Care in Special Operations“ in 1996 [4]. These were the first innovative and scientifically based recommendations for casualty care under tactical constraints and the foundation of today‘s Tactical Combat Casualty Care (TCCC) Guidelines [22]. Initially used only in the special forces sector, these concepts gained increasing importance for regular military units under the pressure of the loss-heavy conflicts in Afghanistan and Iraq [16].

With the „Committee on TCCC“ (CoTCCC), a body was created whose recommendations were soon also adopted by civilian US institutions. The National Association of Emergency Medical Technicians (NAEMT) has incorporated the TCCC Guidelines into the „Prehospital Trauma Life Support“ (PHTLS) and has become a partner of the CoTCCC [22]. The consistent training and application of TCCC in the US Armed Forces led to a significant reduction in the mortality rate in the conflicts in Afghanistan and Iraq [9][10][24][26][27][28][34].

Internationally, the TCCC Guidelines are increasingly established and are used as the basis for tactical casualty care. However, since these cannot be implemented 1:1 to European standards, working methods, and medications, the „Tactical Rescue and Emergency Medicine Association (TREMA)“ has taken up this topic since 2007 and published the TREMA Guidelines for tactical casualty care [38].

TCCC has developed into a globally recognized standard and is now used not only in the military sector but also by police and rescue units [18][31].

Principles of Tactical Casualty Care

Tactical medicine differs in several key aspects from conventional emergency medicine. While the goal in classical emergency medicine is to ensure optimal medical care, in tactical operational situations, the focus is oncombining care and the tactical situation.

Comparison of Civilian and Tactical Emergency Medicine

 

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Basic Principle:

In civilian emergency medicine, the medical situation determines our approach – in tactical medicine, the tactical situation determines our medical approach and the possible measures!

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Important Principles of Tactical Medicine

The following five principles apply in tactical medicine [14]:

1. “Good medicine may be bad tactics”
   Optimal medical care can be tactically devastating, leading to further losses or mission failure.
2. “Treat first what kills first”
   Treatment begins with the most common avoidable causes of death.
3. “Tourniquet first”
   Critical extremity hemorrhages are treated immediately with a temporary tourniquet.
4.  “Phase-oriented care”
   All measures are directed according to the tactical situation.
5. “Respect the phase of care”
   The complex operational environment in which the TCCC provider operates is illustrated in Figure 3. This highlights the significant difference compared to ‘conventional’ emergency and prehospital care.

The Three Phases of Tactical Combat Casualty Care

Tactical casualty Combat Care has been divided into three phases, characterized by the current threat and risk situation. These phases are crucial for enabling effective care under combat conditions or in other dangerous situations, with the measures that are possible and recommended in this phase [5].

Phase 1: Care Under Fire (CUF) – Care under Fire/Threat

This first phase refers to care while the casualty and the medic (a general term for a soldier with advanced emergency medical training) are still under direct fire or threat – for example, in an ongoing firefight, in the area of an IED, or during a continuing terrorist attack with the danger of a Second Hit.

Goals of the CUF Phase

1. Establish fire superiority
   Turn the tactical situation in one‘s favor, recognize and define the danger area, ward avert further dangers.
2. Minimize further casualties
   The most crucial step is to avoid further injuries. Medical personnel must protect themselves according to the tactical situation while rescuing the casualty.
3. Rapid evacuation to a safer position
   If possible, casualties should be encouraged to take cover themselves (self and buddy aid). Rescue from these areas is allowed without regard for injuries to quickly get out of the danger zone.
4. Minimal medical measures
   Since every intervention takes time and endangers oneself and comrades, treatment in this phase is restricted to a few measures.

Medical Measures in the CUF Phase

• Temporary bleeding control through tourniquets.
  Critical extremity hemorrhages must be stopped immediately with a tourniquet if tactically possible, as these are the most common avoidable cause of death in combat.
• Extreme body proximal hemorrhages should be maximally adressed with manual pressure, if possible, according to the situation.
• No airway management

Since these procedures are too dangerous in this phase, no airways are secured. If the casualty cannot be transported temporarily, a lateral position in the sense of a recovery position is recommended to keep the airways open.

As fast as possible evacuation

If possible, the casualty should be brought to a safer area by themselves or with support.

 

Phase 2: Tactical Field Care (TFC) – Care in a Partially Safe Area

In this situation, there is no immediate threat, but the environment is not fully secured. Here, an extended structured algorithm-based medical care with a focus on life-saving measures is permitted. There is always the need to be able to move with the patient.

Goals of the TFC Phase

• Identification and treatment of critical injuries,
• Prioritization of medical measures according to TCCC algorithms (MARCH, <C>ABCDE, abbreviations see below) and
• Stabilization of the patient for transport.

Algorithms and Measures in the TFC Phase

• Apply the MARCH algorithm
  • Massive Hemorrhage (stop severe bleeding),
  • Airway (maintain/secure airway),
  • Respiration (check breathing, treat tension pneumothorax),
  • Circulation (stop further bleeding, maintain circulation, resuscitation),
  • Hypothermia (prevent hypothermia).

• Application of the <C>ABCDE Algorithm
  • <C> Critical Bleeding (stop critical bleeding),
  • Airway (open or secure airway),
  • Breathing (check breathing and treat tension pneumothorx),
  • Circulation (stop further bleeding, maintain circulation, resuscitation),
  • Disability (neurological examination and analgesia),
  • Exposure (fully expose injuries, prevent hypothermia, if possible, convert applied TQ, prepare for transport).

    

    Fig. 4: Rapid evacuation to a safer position takes precedence over the treatment of injuries. (Image: Bundeswehr/Jana Neumann)

 

Phase 3: Tactical Evacuation Care (TEC) – Care during Evacuation

This phase begins once the casualty has been prepared for transport. Evacuation can be on ground or land, air, or water vehicles.

Goals of the TEC Phase

1. Ensure continuous medical care during transport,
2. Monitor the patient and adjust therapy if necessary,
3. Communicate with the receiving medical facility.

Medical Measures in the TEC Phase

• Reapply the <c>ABCDE/MARCH algorithm for reevaluation,
• Provide oxygen (if available and necessary),
• Continue bleeding control and check tourniquets and, if possible, convert them before transport,
• Continue analgesia and sedation,
• Document measures and communicate with the medical team at the destination.

 

Prolonged Field Care (PFC)/Prolonged Casualty Care (PCC) – Extended Casualty Care

Apart from the classic three phases of Tactical Combat Casualty Care (TCCC – Care Under Fire, Tactical Field Care, and Tactical Evacuation Care – in recent years, Prolonged Field Care (PFC) has emerged as a phase after TCCC, becoming increasingly relevant:

PFC refers to extended medical care in the field that goes beyond all conventional operational medicine planning timelines [25]. It becomes necessary when medical evacuation is not possible or only severely delayed – due to enemy threats, lack of transport means, or weather conditions. This scenario is particularly observed in high-intensity, asymmetric, or logistically overloaded conflicts like in Ukraine [37].

PFC is defined as follows:

“Field medical care applied beyond doctrinal planning timelines in austere environments where evacuation is not immediately possible and where resources may be limited or nonexistent.” [33]

Goals of PFC

PFC pursues, among other things, the following goals:

• Maintain vital functions and nursing measures for hours to days without definitive care facility,
• Avoid secondary complications (e.g., hypothermia, hypoxia, infections, pressure sores),
• Documentation, monitoring, and prioritization of resources, and
• Maintain the operational capability of forces in the environment.

 

Core Statements of the PFC Approach

• “If you can’t evacuate – you must mitigate.”
• “Sustain life, buy time, and prepare for transport.”
• “Train for reality – not for doctrine.”

 

Overarching Principles

For all TCCC phases and the PFC, the following overarching principles apply:

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• The tactical situation always determines medical care.
• Fire superiority is the best medicine in the initial phase.
• Good medicine can be bad tactics.
• Treat first what can kill fastest.
• Stop bleeding, secure airway, enable breathing.
• Fulfill the mission – medically and tactically.

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Conclusion and Relevance for Future Operations

Tactical casualty care has made significant progress in recent decades. Through the introduction of standardized algorithms like TCCC, survival rates have been significantly increased [5].

Key insights are:

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1. Tourniquets and bleeding control are essential.
2. Medical care must adapt to the tactical situation.
3. Specialized training for military, police, and rescue services is necessary.

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New technologies and scientific insights will heavily influence the future of tactical medicine. New hemostatic agents, advanced analgesia, improved protective clothing, and innovative evacuation methods will further optimize care.

Areas of Application for Tactical Medicine

Tactical casualty care is not limited to the military but has also proven indispensable in police, civilian, and humanitarian operational areas. The principles of tactical medicine are applied in various scenarios:

Law Enforcement Application – Tactical Emergency Medical Support (TEMS)

While military medics operate on the battlefield, police forces increasingly find themselves in life-threatening situations – such as in rampages, terrorist attacks, hostage-taking, or complex acts of violence. In these high-risk situations, medical care by regular rescue personnel is often severely delayed or initially impossible. The concept of Tactical Emergency Medical Support (TEMS) was developed to integrate situation-adapted, early medical care directly into police operations [2][18][29]. Based on this, training concepts such as Tactical Emergency Casualty Care (TECC) were developed for non-military police and tactical scenarios.

Challenges of Police Tactical Medicine

• Mission and self-protection
  Medical personnel can only act when sufficient tactical security is ensured.
• Delayed medical care
  In dynamic situations, it can take hours before structured care and evacuation are possible.
• Integration into police structures
  TEMS forces must work closely with special units such as SWAT or GSG 9, be tactically trained, if possible, be incorporated, and operate under conditions close to deployment.

 

Tactical Medicine in Amok and Terror Situations [18][43]

• Police forces must quickly locate, isolate, and neutralize threats before regular rescue services gain access.
• Therefore, regular operational forces are increasingly trained in life-saving immediate measures such as tourniquet application, hemostatics use, wound packing, and chest seal application.
• The initial medical care often takes place under personal protective equipment (PPE), with reduced material and in so-called partially safe areas – parallel to tactical situation management.

 

Tactical Medicine in Terrorist Attacks in the Civilian Context – LebEL (Life-Threatening Operational Situations)

The events in Paris (2015), Berlin (Breitscheidplatz, 2016), London (several attacks in 2017), and other attacks in European metropolises have made it clear that civilian rescue systems must be prepared for complex threat scenarios such as attacks with firearms, explosives, or vehicles. Life-threatening operational situations (German: LebEL) refer to police operations that pose a high risk to the lives of victims, bystanders, and emergency personnel. They are characterized by significant uncertainty, dynamic threats, and the need for tactically coordinated medical interventions. In such scenarios, tactical medicine also plays a crucial role in the civilian sector [23].

Basic Principles within LebEL Care

• Zone Model see Table 2
  Differentiate between unsafe, partially safe, and safe areas, depending on the threat situation.

• Unsafe area
  Only the police act; no medical actions are taken by regular rescue. Tourniquets are applied by trained police personnel.
• Partially secure area
  Protected casualty collections for preliminary triage and treatment of critical bleeding are established, with handover by the police.
• Safe area
  Hospitals are the strategic goal for further medical treatment; they must be made „safe zones“ through structural measures. Self-protection before patient care

Medical measures are subordinated to tactical conditions – “Safety first.“

• <C>ABCDE
  Priority is given to bleeding control (<C>), simple airway measures, and maintaining warmth.

Examples of LebEL:

• Paris 2015
  Multiple simultaneous attack sites with dynamic perpetrator situations – police and rescue forces operated under pressure in changing danger zones [15][20].

• Berlin 2016
  Breitscheidplatz attack – long uncertainty about the perpetrator situation complicated patient care, first responders took life-saving measures [7].

• London 2017
  Social media-based police warning strategy („Run, Hide, Tell“) led to faster self-rescue and relief of operational forces [20].

• Dresden 2023
  Planned multiple attacks by a lone perpetrator highlighted the need for early threat assessment and interdisciplinary alerting.

Tactical medicine in LebEL scenarios requires close cooperation between police, rescue services, and clinics. The goal is to ensure the survival of the injured through coordinated spatial organization, rapid tourniquet application, and priority-oriented transport – while providing maximum protection for operational personnel [18][23].

 

Tactical Medicine in Disaster Operations

In addition to military and police operations, tactical medicine is increasingly being applied in civilian disaster situations, such as earthquakes, tsunamis, or major industrial accidents.

Differences from classical disaster medicine are mainly:

• Lack of medical personnel
  Helpers have to work under extreme conditions with few resources.

• A large number of patients
  In earthquakes or terrorist attacks, there are often hundreds of casualties at once.

• Extended transport times
  In crisis areas, evacuation can take days to weeks (e.g., Haiti 2010, earthquakes in Syria and Turkey 2023).

Example of Tactical Medicine in Disaster Operations

During the Nepal earthquake (2015), specialized teams worked with tactical medical protocols to rescue casualties from hard-to-reach areas [1].

 

Tactical Alpine Medicine

Tactical alpine medicine is a specialized subfield of tactical medicine that focuses on operations in alpine terrain. It is particularly used by military, police, or specialized rescue units – such as in mountain rescue operations under enemy threat, avalanche accidents, or in impassable high mountains [19].

Particularities of Tactical Alpine Medicine are

• Extreme environmental conditions
  Operations often occur under cold, wet, snowy, windy, high-altitude, and steep terrain conditions.

• Combination of medicine and alpine technical knowledge
  Rescue and care must occur in parallel to securing against falls and environmental risks.

• Difficult evacuation
  Casualties must often be carried over long distances in rugged terrain or extracted from alpine zones by winch.

• Limited medical resources
  Minimally invasive, life-saving measures (e.g., tourniquet, pain control, maintaining warmth) are prioritized.

Example of Tactical Alpine Medicine

In operations by special forces or mountain rescue units, such as during avalanche disasters with multiple buried victims, medical teams work under extreme conditions in parallel with rope securing, avalanche search technology, and hypothermia-specific emergency care [19].

 

Tactical Medicine in Offshore Environments

With the expansion of maritime energy infrastructure and strategic objects at sea, medical care in offshore scenarios is gaining importance – even from a tactical perspective. Offshore platforms, wind farms, and maritime operational areas pose particular demands on the medical system due to their isolation, weather dependency, and threat environment (e.g., sabotage, explosions, fire) [41].

Particularities of Offshore Medicine with a Tactical Focus are

• Access restriction and isolation
  Patients often spend hours at sea – without immediate clinical care.

• Complex evacuation logistics
  Evacuations take place via helicopter, crew transfer boats, or rescue capsules – under highly weather-dependent conditions.

• Limited medical equipment
  Trained non-physicians (offshore medics) often provide initial care, supported by telemedicine

• Tactical threat scenarios
  In addition to medical emergencies, security-relevant scenarios (e.g., hostage-taking, sabotage acts, piracy) can occur – especially on supply ships or critical infrastructure.

Example of Tactical Medicine in Offshore Environments

During exercises and real operations, offshore medics and emergency physicians train together with police or naval units to care for injured persons under challenging conditions – such as after explosions or in cases of multiple traumata on wind turbines. The focus is on integrating telemedicine, structured emergency care, and tactical situational awareness [41].

Tactical Medicine in Austere and Wilderness Environments

Tactical medicine is increasingly important in extremely remote, resource-poor, or so-called „austere“ operational environments – such as in remote areas, deserts, jungles, mountains, or arctic regions. The boundaries between tactical, austere, and wilderness medicine are fluid. Training and research institutions increasingly define this area as an independent field of action within mission-oriented medicine [42].

Particularities of Austere/Wilderness Medical Care

• Minimalist equipment
  Care is provided without standard devices, often only with portable material in the form of a medical backpack or the personal material of the daypack.

• Extended treatment time (Prolonged Field Care)
  Medical care must be provided for many hours or days without secured evacuation possibilities.

• Expanded role distribution
  Non-physicians (e.g., medics or operational paramedics) also take on extended measures such as airway management, pain therapy, or wound care.

• Environmental challenges
  Extreme temperatures, humidity, altitude exposure, wild animals, or toxic plants influence diagnostics and care.

• Communication and navigation
  Reduced or absent network connections require redundant communication means (e.g., satellite radio) as well as map and GPS competence.

Example Scenarios for Austere and Wilderness Medicine

• Care of a polytraumatized soldier after a crash in alpine terrain in adverse weather.
• Evacuation of a wounded person from a jungle area with an improvised stretcher and limited equipment, or
• long-term monitoring and treatment of a hypothermic patient without the possibility of evacuation.

Austere and Wilderness Medicine are demanding sub-disciplines of tactical medicine. They require improvisation talent, physical resilience, and a high level of medical decision-making ability under uncertainty. Training programs increasingly align with international standards (e.g., wildernessmedicine.com) and include simulation-based learning, practical field competence, and interdisciplinary scenarios [11].

Why is Tactical Medicine More Important Than Ever? – Insights from Ukraine

Tactical casualty care has evolved over the past decades from exclusive military applications to an increasingly societal tool for survival assurance. The war in Ukraine since 2022 shows with unprecedented clarity the challenges modern, high-intensity, and hybrid conflicts pose to medical care. The experiences from the Ukraine war offer essential lessons for further developing tactical medicine in the context of national and alliance defense, international crisis management, and civilian disaster scenarios.

The more than 20 years of experience gained in Afghanistan and Africa and the substantial advancement of tactical medicine during that time form the foundation for the current situation. However, it must be adapted to reflect the duration and intensity of care and the increased threat to medical personnel. and duration of care as well as their own threat.

Tactical Medicine in Modern Wars: The Ukraine War as an Example

The Russian war of aggression against Ukraine is the largest conventional war in Europe since World War II. It is characterized by a combination of classical warfare, urban combat, technological reconnaissance, and targeted attacks on critical infrastructure. The healthcare system is particularly affected, systematically targeted by attacks. Between February and December 2022, according to a comprehensive study, 707 documented attacks on health facilities, rescue vehicles, and medical personnel were registered [6].

The Core Impacts and Challenges of the Ukraine War Are

1. High number and complex quality of injuries

• Explosion trauma, multi-system injuries, and amputations are common injury patterns caused by drones, artillery, and landmines [6][36].
• Thermobaric weapons lead to difficult-to-diagnose internal injuries [36].

2. Lack of air superiority and delayed evacuation

• Unlike previous operations in Afghanistan or Iraq, air evacuation (MEDEVAC) is hardly possible.

• Long transport times force Prolonged Field Care (PFC) under the simplest conditions [36].

3. Danger to medical personnel and infrastructure

• The Red Cross‘s protection status is largely ignored. Medical facilities are deliberately shelled [6][36].
• Medics are forced to operate in improvised ORs, basement rooms, or without electricity and water [36].

4. Importance of civilian first responders and TCCC training

• Ukraine has trained tens of thousands of civilian first responders according to TCCC standards [6][36].
• Tourniquets, chest seals, and training scenarios are widespread in many households, comparable to first-aid kits in cars [36].

5. Prolonged Field Care and new care concepts

• New care chains with Forward Surgical Elements in protective structures and mobile treatment units in bunkers are emerging.
• Classic models (e.g., tent or container with an OR table) are considered outdated.

6. Non-medical personnel as a central resource

• Future doctors cannot be trained in the necessary number and quality, therefore, both civilians and soldiers must be trained in the most important measures according to TCCC in a cross-sectional and stepwise manner. Interdisciplinary cross-training at all levels of care.

 

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Lessons from the Ukraine War for NATO, Bundeswehr, and Civilian Structures:

• Bleeding control and pre-hospital transfusions must be further developed and adequately trained (keyword: TQ conversion, junctional tourniquets, AAJT-S, cold-stored whole blood).
• Training and logistics concepts must be adapted to realistic large-scale damage scenarios. The experiences from stabilization operations and IKM in Afghanistan, Iraq, and Africa must not be forgotten. Here, adaptation, especially to the quantity and duration of care, is necessary.
• Civilian structures must be enabled to apply tactical medicine in the context of terror situations and blackout scenarios.

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The Ukraine war highlighted classical casualty care’s limits and defined a new paradigm for tactical medicine: mobile, fast, robust, decentralized, interoperable and resilient. Tactical medicine is no longer exclusive knowledge for special forces but an essential component of societal resilience. The medical corps of the Bundeswehr and its partners and civil-military structures must use these insights to be prepared for what is to come.

Conclusion: Tactical Medicine and Casualty Care as an Indispensable Capability

Tactical casualty care has evolved into one of the most important medical disciplines in recent decades – not only for the military but also for police, rescue services, and civilians.

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Why is Tactical Medicine So critical?

• It saves lives in combat, danger, and disaster situations.
• It works adapted to the tactical situation.
• It bridges the time until actual medical care.
• It prepares for future threat scenarios – from wars to terrorist attacks.

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Manuscript Data

Citation

Josse F: Tactical Medicine and Tactical Casualty Care: History, Development, Principles, and Areas of Application. WMM 2025; 69(6E): 2.

DOI: https://doi.org/10.48701/opus4-507

Author

Lieutenant Colonel (MC) Dr. Florent Josse, MD

Bundeswehr Hospital Ulm

Department of Anesthesiology, Intensive Care, Emergency Care, Pain Treatment

Oberer Eselsberg 40, D-89081 Ulm

E-Mail: florentjosse@me.com