Comments on Casualty Evacuation & Treatment

Useful Patrol Training Video
July 26, 2013
Swift Tip for the Week
July 31, 2013
First, I’ll say that this will be a brief post because I will be at the training site all week and have a training weekend coming up. I will be posting less frequently this week, if at all, but I will have access to the internet via cellphone and will respond to any interesting comments or questions as appropriate/possible.
The point of this post is to respond to some interesting comments on this post: Useful Patrol Training Video: there is a discussion in comments about the medical protocols shown in the linked TV show and how it relates to the availability of definitive care at a hospital.
This is very relevant and it is something that I discuss when teaching TC3 (Tactical Combat Casualty Care). (As an aside, it also shows the necessity, as I often remark, of breaking away from a dogmatic reliance on sources such as military doctrine/FM’s and training where it need amendment or does not apply).
This is not intended to be a post on TC3 protocols in detail. Although I skimmed watching the medical parts of the linked video, I did listen enough to hear discussion about the ‘Golden Hour’, which applies to the window of treatment desirable for best chance of recovery for a casualty. The Naval surgeon on the show, Rick Jolly, is legendary in the field from his actions in the Falklands War. He utilized  techniques such as leaving the gunshot/shrapnel wounds open for several days to reduce infection. Interestingly, in discussion with a British Military surgeon in Southern Iraq, I discovered that the British Army protocols were changed to a two hour window or ‘Golden 2 hours’ simply because of a mixture of long transit times across the desert even in medevac choppers, and also better skills and equipment utilized by medics for keeping people alive until they could reach the hospital. Interesting how the reality of transit times changed the understanding of the ‘golden hour’!
The three phases of TC3 can be summed up as:
1. Care under Fire
2. Tactical Field Care
3. Evacuation and definitive care at a hospital
This is where the commenters are right, and TC3 starts to lose its utility in an environment where we don’t have ‘dust-off’ to the Combat Hospital (CASH), or we don’t have a civilian ambulance to the nearest emergency room. This is what I am careful to explain in my classes: 
In an SHTF or Resistance environment, you won’t have those resources to evacuate your casualty to. You may have something, but it won’t be the CASH or the emergency room. Do you have a nurse in your group, a veterinarian, and EMT, a general practice doctor, an OBGYN for example, or did you just read up on wound treatment yourself and maybe take a couple of courses?
You have to appreciate and remember that all the things that a combat lifesaver or combat medic does at the point of wounding is designed to keep the casualty alive until they can be evacuated to definitive care. If there is no definitive care, then it is no good keeping the casualty alive in the first instance if they are to die later. It is, for example, fine to put a tourniquet on a wounded limb ‘high and tight’ in the care under fire phase, but unless you can ultimately downgrade and then remove it without the casualty dying them they will lose the limb. We could be talking about an 1860’s level of definitive care here with ‘sawbones’ doctors taking off limbs and casualties surviving or dying from blood loss and infection as a matter of chance.
In the video, the four man SAS patrol was behind enemy lines and on the run, and had to leave their wounded comrade. All they could do for the dead guy was to take his weapons and ammo. That is a far cry from ‘no man (or body) left behind’ U.S. Military doctrine that is achievable because the U.S. has the assets to be able to act like that. In an SHTF or Resistance environment there will be hard decisions to make. 
This does not mean give up on your casualties. It does not mean that TC3 protocols are worthless, because they are not. If you follow them, you will stand a better chance of keeping your casualties alive after wounding, and of successfully keeping them alive as you evacuate them by whatever means possible.
What you need to give serious thought to, and prepare for, is what to do after you have initially saved them. How will you evacuate them? What medical treatment can you give them? Do you have medically trained personnel to assist? If you don’t, then are you able to clean, debride and dress a wound? What about antibiotics – if we are back to ‘old school’ medicine then most of these casualties, if they survive the initial wounding, blood loss and treatment, would die from infection, particularly after an amputation. 
Food for thought.
Live Hard, Die Free.


  1. Anonymous says:

    I’m not sure exactly what type, but I’ve heard that some pet fish anti-biotics work on Humans, the benefit being that no prescription is needed and can be found in quantity. We cant expect 1st class medical care, but something is better than nothing! Before penicillin, infections killed more soldiers than wounds did.

  2. Anonymous says:

    Politics has as one element, that of addition. So this means add doctors trauma nurses and highly qualled medics. We do have a great recruiter, the people opposite of us are real dicks. robroy

  3. Anonymous says:

    One thing the bulk of the FREEFOR don’t seem to understand is how TIGHTLY regulated and controlled the trained medical person’s are. They must document EVERYTHING they do when treating anyone-for ANYTHING- not reporting a “crime of violence” is an automatic criminal charge, They MUST do this even if they don’t treat the victim . The government considers them part of the Just-us system. Everything they do is “chain of evidence”. Further MDs. are heavily monitored by the DEA IRS DHS LEO’s and a host of state agents. OPSEC is going to be a real fundamental issue for these people. It is now routine for MDs. to be kept under the watchful eye of the DEA and FBI.(Vets too) in order to “weed out” “bad doctors” and “fight the war on drugs” We need be very careful how we contact these people, (MOST of the younger ones are RABIDLY anti-gun- anti-militia -anti violence fanatics.) The government has spent the last 40 years demonizing the “militia”-so if we want to recruit Doctors and Nurses then we had best put our best foot forward. Medics are HIGHLY TRAINED and HIGHLY EDUCATED Most with years or decades at there profession and they will not suffer fools lightly.

    • Anonymous says:

      Those medical professionals that are not true believers and have the means are getting out of the system before their skill and labor is collectivized.

      In recruitment, might this be a case where older is better?

    • Anonymous says:

      And yet people get treated all the time off the books. Just dont show up to a hospital and expect to keep things on the low down. You need a barn or shed that is set up BEFORE! things get nasty. You need a doc in the box that can do the work in exchange for barter items. Be on the look out for Docs and nurses that the ObamaCare system is shuting out of business. Find yourself a doctor that runs a “pain management” clinic. Odds are he is very much aware of the heavy hand of government and knows how to get around those regs. As for me…my cousin is a Nurse.


  4. Anonymous says:

    Good sober commentary, Max.

    Most valuable brains to get for one’s tribe?

    Chemists and MD/PAs.

    Think on it, mates.

  5. Hey Admin ! You write awesome post,
    .Thank You.

  6. Indeed fish antibiotics are the exact same as human antibiotics. The trick is knowing how to use them.
    This was recently posted there. I hope that’s helpful. It was timely for sure!

    Also there is a rather lengthy survivalist fiction piece on the webz about a nurse who secretly sets up a field hospital in a farmhouse. It’s called “Patriot Aid Station”. It’s chock full of little details and lists of equipment and procedures, although the fiction subplots are a bit stilted. I guess that can be par for the genre though.

  7. I also need to add that WRSA just posted a link to a page with a lot of medical field manuals the other day.
    Here it is

  8. Night Driver says: Print version…. one source for the .pdf another source.

    Book title is:

    Survival and Austere Medicine: An introduction
    Second Edition

    Written and Edited by The Remote, Austere, Wilderness and Third World Medicine Discussion Board Moderators

    A third edition has sort of been rumbling about for a couple years (real life keeps iintervening, as it were)…..