Prehospital advances in the management of severe penetrating trauma

Crit Care Med. 2008 Jul;36(7 Suppl):S258-66. doi: 10.1097/CCM.0b013e31817da674.


Background: Historic advances in combat prehospital care have been made in the last decade. Unlike other areas of critical care, most of these innovations are not the result of significant improvements in technology, but by conceptual changes in how care is delivered in a tactical setting. The new concept of Tactical Combat Casualty Care has revolutionized the management of combat casualties in the prehospital tactical setting.

Discussion: The Tactical Combat Casualty Care concept recognizes the unique epidemiologic and tactical considerations of combat care and that simply extrapolating civilian care concepts to the battlefield are insufficient.

Summary: This article examines the most recent and salient advances that have occurred in battlefield prehospital care driven by our ongoing combat experience in the Iraq and Afghanistan and the evolution around the Tactical Combat Casualty Care concept.

Publication types

  • Review

MeSH terms

  • Afghanistan
  • Analgesia / trends
  • Emergency Medical Services / organization & administration*
  • Fluid Therapy / trends
  • Hemorrhage / etiology
  • Hemostatics / therapeutic use
  • Humans
  • Hypothermia / etiology
  • Iraq
  • Iraq War, 2003-2011
  • Military Medicine / education
  • Military Medicine / organization & administration*
  • Monitoring, Physiologic / trends
  • Pneumothorax / etiology
  • Resuscitation / education
  • Resuscitation / methods
  • Resuscitation / trends
  • Tourniquets
  • Transportation of Patients / organization & administration
  • Triage / organization & administration
  • United States / epidemiology
  • Wounds, Penetrating / complications
  • Wounds, Penetrating / mortality
  • Wounds, Penetrating / therapy*


  • Hemostatics