Tactical management of urban warfare casualties in special operations

Military Medicine, Apr 2000 by Butler, Frank K Jr

41. Urban warfare casualties should generally be moved to the best tactical location as quickly as possible before treatment for their injuries is undertaken.

42. Urban warfare may result in blunt trauma casualties from fast-rope injuries, falls, and motor vehicle accidents. Casualties with possible spinal cord injuries from these mechanisms may need to be moved to cover before long spine boards and C-collars are available. Improvised spine boards may be fashioned from doors or other available materials. If these substitutes are not readily available and the risk of hostile fire injury to the casualty requires immediate movement, the casualty may be grabbed by the shoulders of his uniform, the head stabilized by the forearms, and the casualty dragged along the ground to cover. Avoid maneuvers like the shoulder carry in these casualties if possible.

43. Retrieval of casualties from open areas was often complicated by intense small arms fire in Mogadishu. Improved casualty retrieval and area-denial methods to include smoke, diversions, custom-made or field-expedient casualty retrieval devices (such a length of line with a snap link), pursuit deterrent munitions, use of vehicles for cover, and improved gunfire support plans for the urban environment need to be developed and used.

44. There were no advocates on the panel for attempting CPR in the tactical setting for individuals in cardiac arrest as a result of penetrating or blast trauma.

45. Imposition of casualties at various points in the mission should be a routine part of rehearsals and training for SOF missions. It is important to consider not only how the casualty's injuries should be treated, but also the tactical implications of the casualty upon the ongoing mission.

46. The presence of hearing loss (tympanic membrane rupture) as a result of blast injury should alert the treating medic or corpsman to the possibility of blast injury to the gastrointestinal tract or lungs.

47. Because of potential prolonged delays prior to evacuation in the urban environment, consideration should be given to preparing prepackaged replenishment medical supplies, water, and ammunition that could be air-dropped to trapped units in future engagements.

48. Urban warfare with combatants riding in motor vehicles may result in significant numbers of individuals with blast trauma. The pathophysiology and management of blast trauma (to include blast lung, arterial gas embolism, and late sepsis from gastrointestinal rupture) should be included in combat medical training courses.

49. For casualties with penetrating head trauma, there is little data to show that care rendered in the pre-hospital environment (beyond stopping any significant external bleeding that may be present) is reliably effective in improving outcome.

50. Unconscious casualties should be transported in a lateral decubitus position if possible. This position offers more protection to the airway than the supine position.

51. Pneumatic splints can be used to construct a field-expedient cervical spine collar.