When I began my surgical training at Parkland Memorial Hospital, the “golden hour” had been well established in trauma care for many years. The “golden hour” refers to the period shortly after a traumatic injury during which immediate medical attention greatly increases a patient’s likelihood of recovery. For decades, emergency departments and trauma centers across the United States have worked to provide the highest level of medical care possible during the golden hour.
My career would teach me that the golden hour does not begin once a patient arrives at an emergency department; rather, it begins at the scene of the injury and is often shrouded in confusion until EMS or hospital personnel arrive.
It is at that point that tactical emergency medicine bridges the gap between the two.
How Military Methods Were Adapted In Civilian Trauma Response
Civilian trauma response has benefited from the application of techniques developed in military medicine. As the U.S. military evolved its method of providing life-saving treatment to combat casualties in areas remote from access to traditional medical care, it created a structured method of treating traumatic injuries in environments where no traditional medical resources existed – this is called Tactical Combat Casualty Care (TCCC).
As research and training continued to evolve, the civilian world adopted the structured TCCC approach to develop the concept of Tactical Emergency Casualty Care (TECC). TECC uses evidence-based practice to instruct law enforcement, firefighters, EMS personnel, and other trained civilians in performing safe, evidence-based practices to treat a victim of a traumatic injury until they can be transported to a hospital for further evaluation and treatment.
This is not meant to replace EMS or trauma teams but to assist in delivering the most beneficial care to the victim as soon as possible.
Why Early Intervention Is So Important
There is a broad consensus throughout the medical community that early recognition and early intervention can result in improved outcomes for patients who experience trauma.
Simple, appropriate treatments such as stopping bleeding and maintaining a patent airway can help keep a patient stable until EMS arrives. These initial steps require little in terms of specialized equipment – only preparation, training, and confidence.
Tactical medicine emphasizes these fundamentals.
Education as a Training Tool
A great deal of my work with first responders has focused on developing confidence through a structured educational process.
Regardless of whether I am conducting hands-on training with law enforcement officers, coordinating with local EMS agencies, or educating students in academic settings, the primary objective of all my training is consistent: to ensure that responders understand which actions will yield the greatest benefit in the earliest minutes of a trauma incident.
Recently, training in this area has grown extensively. Today, numerous public safety agencies include bleeding control instruction in their standard curricula. Additionally, schools, universities, and employers have also taken part in this effort, typically through community-based initiatives such as the Stop the Bleed initiative.
Local preparedness grows fastest when it begins locally.
Collaboration Across Disciplines
Recently, one of the most important aspects of tactical medicine’s growth has been the increasing cooperation between healthcare institutions and first responders.
Trauma surgeons, EMS physicians, law enforcement medical directors, firefighters, public health professionals, and federal partners are working together to ensure that the tactics employed by each group are complementary and mutually supportive. When groups collaborate like this, they can build a continuum of care from the moment of injury through hospital treatment and recovery.
When systems are in alignment, care is much smoother.
The Future of Trauma Care
The future of trauma care will remain dependent on the same type of teamwork as in the past – hospitals, EMS services, and public safety agencies will all continue to play critical roles. Integrating the concepts of tactical medicine into civilian responses to traumatic incidents represents a logical progression of a shared mission: to provide high-quality care to the patient as quickly as possible.
I firmly believe that as more individuals receive high-quality training and as agencies continue to work together, we will see improvements in care that will benefit communities around the world.
The golden hour will remain a critical component of trauma care. Where it begins, however, is expanding.
And that is a positive trend.
