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remaining first line interventions for the early years of 2. Fisher A. The MARCH algorithm in Tactical Combat Casu-
the next armed conflict. 9,10 alty Care. The Havok Journal. September 3, 2018. https://
havokjournal.com/fitness/medical/march-algorithm/. Accessed
An Army command sergeant major who regularly attended November 10, 2018.
SOCMSSC until his retirement after 30 plus years in SOF, re- 3. Kotwal RS, Butler FK Jr. Junctional hemorrhage control
called his first SF team in the ‘70s. This team was composed for tactical combat casualty care. Wilderness Environ Med.
2017;28(2):S33–S38.
mostly of Vietnam veterans and had a standard operating pro- 4. Kotwal RS, Butler FK, Gross KR, et al. Management of junc-
cedure that dictated that during deployments each teammate tional hemorrhage in Tactical Combat Casualty Care: TCCC
carry an extra-long web belt along with a canteen. This SOP guidelines proposed change 13-03. J Spec Oper Med. 2013;13
was an early example of junctional hemorrhage management (4):85.
before the term “junctional hemorrhage” had been coined. 5. Kragh JF Jr, Wallum TE, Aden JK III, et al. Which improvised
tourniquet windlasses work well and which ones won’t? Wil-
• Lessons learned regarding hemorrhage control will be derness Environ Med. 2015;26(3):401–405.
forgotten if their importance goes unrecognized. 6. Gaspary MJ, Zarow GJ, Barry MJ, et al. Comparison of three
junctional tourniquets using a randomized trial design. Pre-
Finally, casualty response is not only a medical emphasis but hosp Emerg Care. 2018:1-8. doi:10.1080/10903127.2018
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an overall emphasis of the operational leadership and requires 7. Alterie J, Dennis AJ, Baig A, et al. Does pain have a role when
integration into comprehensive and realistic training scenar- it comes to tourniquet training? J Spec Oper Med. 2018;18
ios and should be considered a core training requirement of (3):71–74.
all organizations (military and civilian) that encounter casual- 8. Jacobs LM, McSwain NE Jr, Rotondo MF, et al. Improving
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Disclaimer 9. Jenkins DH, Cioffi WG, Cocanour CS, et al. Position state-
There are no relevant financial conflicts of interest to disclose. ment of the Coalition for National Trauma Research on the
The listing of devices by brand name does not constitute en- National Academies of Sciences, Engineering and Medicine
dorsement on the part of the author. Any preference shown report, a National Trauma Care System: integrating military
towards one device over another was a genuine attempt at and civilian trauma systems to achieve zero preventable deaths
after injury. J Trauma Acute Care Surg. 2016;81(5):816–818.
providing the most useful information to the force from what 10. Mabry RL, DeLorenzo R. Challenges to improving combat
was currently available. casualty survival on the battlefield. Mil Med. 2014;179(5):
477–482.
Disclosure 11. Dickey NW. Combat Trauma Lessons Learned from Military
The authors have nothing to disclose. Operations of 2001-2013. Defense Health Agency/Defense
Health Board Falls Church United States; 2015. http://www.
References dtic.mil/dtic/tr/fulltext/u2/1027320.pdf. Accessed November
1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battle- 11, 2018.
field (2001-2011): implications for the future of combat casu-
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