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TACTICAL EMS PROTOCOLS Spinal motion restriction: Despite traditional EMS teachings that indicate the need to perform SMR with most blunt and penetrating trauma, this practice requires bulky equipment and multiple providers. We must recognize the low incidence of cervical spine (c-spine) inju- ries associated with penetrating trauma, the leading cause of combat injury.14 SMR is not likely to be practical in the tactical environment. For these reasons, the TCCC and Prehospital Trauma Life Support (PHTLS) curricula recommend deferring SMR until the patient can be safely extracted to the cold zone.15 HEMORRHAGE CONTROL The most common cause of prevent- able battlefield death is exsanguination from an extremity wound.16 These are wounds in which hemorrhage could have potentially been controlled with the use of a tourniquet. During the Care Under Fire phase, control of hemorrhage is the top priority.13 Tourniquets: Tourniquets in the prehospital setting can be safe and effec- tive.13 There is also a lack of evidence supporting the use of limb elevation or pressure points to control extremity hemorrhage when direct pressure is not effective.16 For this reason, the tactical medic might utilize a tourniquet earlier than would be considered in a conven- tional EMS setting.15 The temporary use of tourniquets in the tactical environment frees the rescuer's hands for other tasks including self-defense.14 When tour- niquets are applied in the CUF phase, in order to conduct an extraction, the bleeding site should be reassessed and tourniquet removal considered as circumstances permit.20 Hemostatic agents: Not all hemor- rhage can be controlled with the use of direct pressure or the application of a The most common cause of preventable battlefield death is exsanguination from an extremity wound. tourniquet. Potentially complicated sites of hemorrhage include the most proximal aspect of the extremities, the axilla, groin, torso and neck.14 ACEP also places the Amazing & Affordable 800-424-7989 | www.prestanproducts.com Prestan Professional CPR/AED Manikins Visit us online and watch a short video to learn more! For More Information Circle 15 on Reader Service Card EMSWORLD.com | FEBRUARY 2012 29 Photo by John Erich