Editorial
Dear Readers,
With the establishment of the Tactical Medicine Working Group of the German Society for Military Medicine and Military Pharmacy a milestone has been laid in the improvement of the care of the wounded and injured on the battlefield. The working group will focus particularly on Tactical Combat Casualty Care (TCCC), tactical medicine, and „austere environment“ scenarios, serving as the scientific leadership for the Combat Medical Care Conference. I wish to use this preface to express my deep gratitude and respect to the organizers, especially Lieutenant Colonel Dr. Florent Josse, for their long-standing efforts.
The necessity to address the particularities of medical service provision in combat is a compelling deduction from physiological and pathophysiological principles, well known to you all as the „Golden Hour“ with the principle „Treat first what kills first.“ We must not tire of highlighting these insights and the resultant measures to both our professional juniors and to the circle of „non-medical troop leaders.“
The fundamentals of tactical medicine, as well as the necessary planning and processes, are professionally presented and explained in this issue. These fundamentals serve as a guide even before actual deployment during training, ensuring they can be reliably recalled during operational situations. Tactical casualty care began in the Bundeswehr around the 2000s. Tactical medicine (TCCC) was initially introduced as an extended self and buddy aid by special forces and reconnaissance units. With the initiation of the 1st TCCC Symposium by Lieutenant Colonel Dr. Josse at the Special Operations Training Center, TCCC measures and algorithms were made public for both special forces and conventional forces and medical personnel, initially sparking considerable debate. With deployments in Afghanistan, casualty care under combat conditions gained importance. The TCCC Symposia in Pfullendorf have since addressed this topic annually, and since 2010, even non-medical personnel have been empowered with extended emergency medical measures through the „Bravo“ First Responder training. The „Team Training in Tactical Casualty Care“ courses have also integrated the algorithms and procedures of tactical medicine into the training of qualified medical personnel. Starting in 2014, the CMC-Conference was held in Ulm, quickly establishing itself as the largest and most important conference on tactical operational medicine.
The experiences from deployments in Afghanistan and Mali are now the starting point for further adaptations in tactical operational medicine, considering the expected casualty rates within the respective timelines and the transport conditions for surgical care in the future intensive military engagements within the framework of LV/BV. Much of what we currently see regarding injury patterns from Ukraine, such as the Tourniquet (TQ) conversion, we began training over 10 years ago. We are on the right path but must always be ready to learn new things and incorporate them into care principles.
Establishing an Institute for Tactical Operational Medicine would be a logical consequence. This would elevate research and teaching to a university level and on par with traditional medical disciplines. Particularly through technical innovations and advancements like „drones“ and „robot-assisted surgery,“ it is crucial to develop tactical operational medicine continuously.
I wish you, esteemed readers, much enjoyment in your reading.
Yours,
Dr. Johannes Backus
Major General (MC)