Download PDF
NOTARZT 2015; 31(06): 316-327
DOI: 10.1055/s-0041-108484
Zusatzweiterbildung Notfallmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Taktische Medizin – Notfallmedizin im militärischen Einsatz

Tactical Combat Casualty Care
W. Schmidbauer
1   Abteilung Anästhesie, Intensivmedizin, Notfallmedizin und Rettungsdienst, Bundeswehrkrankenhaus Berlin
,
T. Hauer
2   2Abteilung Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Berlin
,
R. Lechner
3   Division Schnelle Kräfte, Bundeswehrkrankenhaus Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
18 December 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der weltweite Einsatz von militärischen Kräften erfordert grundsätzlich eine sanitätsdienstliche Unterstützung, die so früh und effektiv wie möglich die notfallmedizinische Versorgung verwundeter Soldaten sicherstellt. Um dieses Ziel zu erreichen, wurde in den letzten Jahren ein strukturiertes Versorgungskonzept unter dem Begriff „Taktische Medizin“ mit der taktischen Verwundetenversorgung als einen wichtigen Baustein aufgebaut und seitdem kontinuierlich weiterentwickelt. Darin werden sowohl die zu erwartenden Verletzungen als auch die limitierten Ressourcen unter Feldbedingungen berücksichtigt. Dieser Artikel soll eine Übersicht über den aktuellen Stand der taktischen Medizin vermitteln.

Abstract

Global military missions require effective prehospital medical care for wounded soldiers as soon as possible. Tactical Combat Casualty Care (TCCC) is a structured algorithm that was developed to address this issue; it takes into consideration both the injuries that are to be expected as well as the limited resources available under field conditions. This article summarizes the current stateoftheart of TCCC.

Kernaussagen

  • Die Versorgung verletzter Personen in einem militärischen Umfeld wird durch die Konzepte der taktischen Medizin beschrieben.

  • Dieses Konzept ist in die 3 Phasen Care Under Fire, Tactical Field Care und Tactical Evacuation Care unterteilt.

  • Das Stoppen lebensbedrohlicher Blutungen, die Entlastung eines Spannungspneumothorax, die Schockbehandlung und ein effektives Temperaturmanagement sind wesentliche Punkte der Versorgung unter taktischen Bedingungen.

  • Nach erfolgter Stabilisierung des Patienten müssen diese so schnell wie möglich evakuiert werden.

  • Der gegenseitige Austausch zwischen ziviler Traumaversorgung und Taktischer Medizin sollte im Bereich Weiterentwicklung und Ausbildung ausgebaut werden.

Schlüsselwörter

Taktische Verwundetenversorgung - Blutung - Kreislaufstabilisierung - Analgesie - Wärmemanagement

Keywords

tactical combat casualty care - hemorrhage - resusitation - analgesia - temperature management
 

  • Literatur

  • 1 Butler FK, Hagmann J, Butler EG. Tactical combat casualty care in special operations. Mil Med. 1996; 161 Suppl. 3-16
    PubMedGoogle Scholar
  • 2 Hossfeld B, Josse F, Bohnen R, Garling A, Lampl L, Helm M. TEMS – Taktische Medizin im Rahmen von Einsätzen der Strafverfolgungsbehörden. Notfallmedizin uptodate 2015; 10: 33-43
    PubMedGoogle Scholar
  • 3 https://www.jsomonline.org/TCCC.html (zuletzt eingesehen am 26.07.2015)
    PubMed
  • 4 http://tremaonline.info/wp-content/uploads/2013/06/TREMA-e.V.-Guidelines-fuer-TCCC-2.0.pdf
    PubMed
  • 5 Holcomb JB. Understanding Combat Casualty Statistics. J Trauma. 2006; 60: 397-401
    CrossrefPubMedGoogle Scholar
  • 6 Ball CG. Damage control resuscitation: history, theory and technique. Can J Surg. 2014; 57: 55-60
    CrossrefPubMedGoogle Scholar
  • 7 Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, Butler FK, Kotwal RS, Holcomb JB, Wade C, Champion H, Lawnick M, Moores L, Blackbourne LH. Death on the battlefield (2001–2011): Implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012; 431-7
    PubMedGoogle Scholar
  • 8 Seamon MJ, Fisher CA, Gaughan J, Lloyd M, Bradley KM, Santora TA, Pathak AS, Goldberg AJ. Prehospital procedures before emergency department thoracotomy: „scoop and run“ saves lives. J Trauma. 2007; 63: 113-20
    CrossrefPubMedGoogle Scholar
  • 9 Kleber C, Giesecke MT, Tsokos M, Haas NP, Buschmann CT. Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World Journal of Surgery. 2013; 37: 1154-1161
    CrossrefPubMedGoogle Scholar
  • 10 S-3 Leitlinie Polytrauma / Schwerverletzten-Behandlung. AWMF-Registernr. 012/019.2011. www.awmf.org/leitlinien/detail/II/012-019.html (zuletzt eingesehen am 21.07.2015)
    PubMedGoogle Scholar
  • 11 Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013; 17 (Suppl. 02) R76
    CrossrefPubMedGoogle Scholar
  • 12 Kragh JF, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009; 249: 1-7
    CrossrefPubMedGoogle Scholar
  • 13 Josse F, Helm M, Kulla M, Ladehoff K, Hossfeld B. Präklinische Blutstillungsmaßnahmen: das Tourniquet. Notarzt. 2015; 31: 101-107
    PubMedGoogle Scholar
  • 14 Bennett BL, Littlejohn LF, Kheirabadi BS, Butler FK, Kotwal Rs, Dubick MA, Bailey Ja. Management of External Hemorrhage in Tactical Combat Casualty Care: Chitosan-Based Hemostatic Gauze Dressings – TCCC Guidelines-Change 13-05. J Spec Oper Med. 2014; 14: 40-57
    PubMedGoogle Scholar
  • 15 Kulla M, Hinck D, Bernhard M, Schweigkofler U, Helm M, Hossfeld B. Prähospitale Therapiestrategien für traumaassoziierte, kritische Blutungen. Notfall Rettungsmed. 2014; 17: 575-583
    CrossrefPubMedGoogle Scholar
  • 16 Bennett BL, Littlejohn L. Review of new topical hemostatic dressings for combat casualty care. Mil Med. 2014; 179: 497-514
    CrossrefPubMedGoogle Scholar
  • 17 Mabry L, Frankfurt A. An Analysis of Battlefield Cricothyrotomy in Iraq and Afghanistan. J Spec Oper Med. 2012; 12: 17-23
    PubMedGoogle Scholar
  • 18 Ramasamy A, Midwinter M, Mahoney P, Clasper J. Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma. Injury. 2009; 40: 1342-1345
    CrossrefPubMedGoogle Scholar
  • 19 Butler FK, Dubose JJ, Otten EJ, Bennett DR, Gerhardt RT, Kheirabadi BS, Gross KR, Cap AP, Littlejohn LF, Edgar EP, Shackelford SA, Blackbourne LH, Kotwal RS, Holcomb JB, Bailey JA. Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02. J Spec Oper Med. 2013; 13: 81-6
    PubMedGoogle Scholar
  • 20 Netto FA, Shulman H, Rizoli SB, Tremblay LN, Brenneman F, Tien H. Are needle decompressions for tension pneumothoraces being performed appropriately for appropriate indications?. Am J Emerg Med. 2008; 26: 597-602
    CrossrefPubMedGoogle Scholar
  • 21 Pattison G. Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure. Injury. 1996; 27: 758
    CrossrefPubMedGoogle Scholar
  • 22 Butler FK, Holcomb JB, Schreiber MA, Kotwal RS, Jenkins DA, Champion HR, Bowling F, Cap AP, Dubose JJ, Dorlac WC, Dorlac GR, McSwain NE, Timby JW, Blackbourne LH, Stockinger ZT, Standenes g, Weiskopf RB, Gross KR, Bailey JA. Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01 – 2 June 2014. J Spec Oper Med. 2014; 14: 13-38
    PubMedGoogle Scholar
  • 23 Werner C, Geldner G, Koch T. Hydroxyethyl starch : position statement by the Presidents of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine), the BDA (Professional Association of German Anaesthetists) and the DAAF (German Academy for Further Education in Anaesthesiology). Anaesthesist 2013; 62: 585-596
    PubMedGoogle Scholar
  • 24 Roessler M, Bode K, Bauer M. Fluid resuscitation in hemorrhage. Anaesthesist 2014; 63: 730-744
    CrossrefPubMedGoogle Scholar
  • 25 CRASH-2 collaborators. Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, Hunt BJ, Morales C, Perel P, Prieto-Merino D, Woolley T. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 2011; 376: 23-2
    PubMedGoogle Scholar
  • 26 Lipsky AM, Abramovich A, Nadler R, Feinstein U, Shaked G, Kreiss Y, Glassberg E. Tranexamic acid in the prehospital setting: Israel Defense Forces‘ initial experience. Injury 2014; 45: 66-70
    CrossrefPubMedGoogle Scholar
  • 27 Onifer DJ, Butler FK, Gross KR, Otten EJ, Patton R, Russell RJ, Stockinger Z, Burrell E. Replacement of Promethazine With Ondansetron for Treatment of Opioid- and Trauma-Related Nausea and Vomiting in Tactical Combat Casualty Care. J Spec Oper Med. 2015; 15: 17-24
    PubMedGoogle Scholar
  • 28 Butler FK, Kotwal RS, Buckenmaier CC, Edgar EP, O‘Connor KC, Montgomery HR, Shackelford SA, Gandy 3rd JV, Wedmore IS, Timby JW, Gross KR, Bailey JA. A Triple-Option Analgesia Plan for Tactical Combat Casualty Care: TCCC Guidelines Change 13-04. J Spec Oper Med. 2014; 14: 13-25
    PubMedGoogle Scholar
  • 29 Hospenthal DR, Green AD, Crouch HK, English JF, Pool J, Yun HC, Murray CK. Guidelines for the Prevention of Infections Associated With Combat Related Injuries. J Trauma. 2011; 71: 210-234
    CrossrefPubMedGoogle Scholar
  • 30 Allen PB, Salyer SW, Dubick MA, Holcomb JB, Blackbourne LH. Preventing hypothermia: comparison of current devices used by the U.S. Army with an in vitro warmed fl uid model. J Trauma. 2010; 69 (Suppl.) 154-161
    CrossrefPubMedGoogle Scholar
  • 31 Butler FK, Blackbourne LH. Battlefi eld trauma care then and now: a decade of Tactical Combat Casualty Care. J Trauma Acute Care Surg. 2012; 73: 5395-402
    PubMedGoogle Scholar
  • 32 Kotwal RS, Butler FK, Edgar EP, Shackelford SA, Bennett dR, Bailey JA. Saving lives on the battlefi eld: a joint trauma system review of pre-hospital trauma care in combined joint operating area— Afghanistan (CJOA-A) Executive Summary. J Spec Oper Med 2013; 13: 77-85
    PubMedGoogle Scholar
  • 33 Klotz JK, Leo M, Anderson BL, Nkodo AA, Garcia G, Wichern AM, Chambers MJ, Gonzalez ON, Pahle MU, Wagner JA, Robinson J, Kragh Jr. JF. First case report of SAM? Junctional tourniquet use in Afghanistan to control inguinal hemorrhage on the battlefi eld. J Spec Oper Med. 2014; 14: 1-3
    PubMedGoogle Scholar
  • 34 Lyon M, Johnson D, Gordon R. Use of a Novel Abdominal Aortic and Junctional Tourniquet to Reduce or Eliminate Flow in the Brachial and Popliteal Arteries in Human Subjects. Prehosp Emerg Care 2015; 19: 405-408
    CrossrefPubMedGoogle Scholar
  • 35 Kragh JF, Kotwal RS, Cap AP, Aden JK, Walters TJ, Kheirabadi BS, Gerhardt RT, DeLorenzo RA, Pidcoke HF, Cancio LC. Performance of Junctional Tourniquets in Normal Human Volunteers. Prehosp Emerg Care 2015; 19: 391-398
    CrossrefPubMedGoogle Scholar
  • 36 Spinella P, Perkins J, Kratewohl K, Beekley A. Warm Fresh Whole Blood Is Independently Associated With Improved Survival for Patients With Combat-Related Traumatic Injuries. J Trauma. 2009; 66 (Suppl. 04) 69-76
    CrossrefPubMedGoogle Scholar
  • 37 O‘Reilly DJ, Morrison JJ, Jansen JO, Nordmann G, Rasmussen TE, Midwinter MJ, Doughty H. Initial UK experience of prehospital blood transfusion in combat casualties. J Trauma Acute Care Surg. 2014; 77: 66-70
    CrossrefPubMedGoogle Scholar
  • 38 Reilly DJ, Morrison JJ, Jansen JO, Apodaca AN, Rasmussen TE, Midwinter MJ. Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study. J Trauma Acute Care Surg. 2014; 77: 114-120
    CrossrefPubMedGoogle Scholar
  • 39 Dretzke J, Smith IM, James RH, Midwinter MJ. Protocol for a systematic review of the clinical eff ectiveness of pre-hospital blood components compared to other resuscitative fl uids in patients with major traumatic haemorrhage. Systematic Reviews. 2013; 3: 123 http://www.systematicreviewsjournal.com/content/3/1/123
    PubMedGoogle Scholar
  • 40 King DR, Larentzakis A, Ramly EP. Tourniquet use at the Boston Marthon Bombing: Lost in translation. J Trauma Acute Care Surg. 2015; 78: 594-99
    CrossrefPubMedGoogle Scholar