FORT BENNING, Ga. (Jan. 7, 2015) -- Future Army leaders were exposed to the importance of tactical combat casualty care, Dec. 17, during the latest edition of the Combat Leader Speaker Program.
Lt. Col. Robert Mabry, director of Trauma Care Delivery of the Joint Trauma System at the U.S. Army Institute of Surgical Research, visited the Maneuver Center of Excellence to share his views on the challenges associated with improving battlefield casualty survival.
"The main challenge we have is determining who owns battlefield medicine," Mabry said. "You would think that the Army Medical Department has ownership of battlefield medicine as its core competency, but in reality, the Army Medical Department conceptualizes care mostly from medical treatment facilities, combat support hospitals, forward surgical teams, and so on. If you look at where we can make the biggest differences in casualty survival, we know from this war that it is in the pre-hospital setting. The combat commander owns that space. He owns the medics, the battalion medical officers and physicians that provide care forward from the combat support hospital."
Mabry helped to develop the concept of tactical combat casualty care during his career, and said it shifts the focus from civilian-based medicine to more common battlefield procedures.
"It basically takes the principles of tactics and where you are in the tactical environment, and looks across combat injuries to find out why Soldiers die," he said. "So, instead of extrapolating civilian pre-hospital care that's built around heart attacks and motor traffic accidents, tactical combat casualty care is a paradigm that looks at why Soldiers die and focuses on key lifesaving techniques that provide the most benefit, such as stopping hemorrhage, decompressing a chest and opening an airway."
While tactical combat casualty care is a good start, he said training on those concepts should be more consistent across the Army.
"Tactical combat casualty care is the standard for the theater, but we have to determine what tactical combat casualty care is," Mabry said. "Is it a two-day course? Is it a slide? Is it a week-long or two-week curriculum like the Rangers have for all their non-medical first responders? Having a uniform standard for all Soldiers out on the battlefield and for combat lifesavers focused around tactical combat casualty care would be key to improving survival outcomes in the future."
Another key change Mabry said he would like to see is an increased focus on training and developing medical personnel who specialize in pre-hospital care.
"Right now, the doctor you get as a battalion surgeon may be a dermatologist or family physician," he said. "We have pre-hospital care as a board-certified specialty, and I think we need to systematically train and expand the role of the pre-hospital specialist. I think a few of these specialists could be placed in key areas where they could interface with places like the Maneuver Center of Excellence, to help work battlefield medical care into our leaders' tool kits."
However, change can't be spearheaded by the medical community alone, he said.
"Our combat arms leaders have to understand that they have to have a role in demanding excellence in pre-hospital battlefield care," Mabry said. "The Army medical community and the line community need to work together to develop doctrine and strategies to improve casualty survival going forward. It's not just a line issue or a medical issue. We're going to have to work together to figure out how to save the most lives in future combat."
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