Interview Questions for Combat First Aid

The MARCH algorithm is a systematic approach to managing casualties in a combat or other high-pressure environment. It prioritizes life-threatening injuries and ensures a logical sequence of care. MARCH stands for Massive hemorrhage, Airway, Respiratory, Circulation, Hypothermia.

• Massive Hemorrhage: This is the absolute priority. Control any uncontrolled bleeding immediately. Think tourniquets, pressure dressings, etc. Death from blood loss happens faster than any other trauma.
• Airway: Once bleeding is controlled, assess and manage the airway. Is it open? Are they breathing? If not, open the airway (jaw thrust, head tilt-chin lift – always being mindful of potential spinal injury) and provide appropriate assistance like a nasal or oropharyngeal airway or even positive pressure ventilation.
• Respiratory: Check breathing rate, depth, and effort. Is it adequate? Look for chest rise and fall, listen for breath sounds. Address tension pneumothorax or other respiratory compromise immediately.
• Circulation: Assess pulse rate, blood pressure (if possible), and capillary refill time. Look for signs of shock (pale skin, rapid pulse, etc.). Control any ongoing bleeding and consider IV fluids if available.
• Hypothermia: Prevent hypothermia (low body temperature), a major killer in trauma patients. Cover the casualty with blankets, and if possible, use warming devices.

In a combat environment, the speed and efficiency of MARCH are crucial. Imagine a soldier wounded in a firefight – rapid control of bleeding using a tourniquet might be the difference between life and death before evacuation.

A penetrating chest wound is a serious injury requiring immediate attention. The first step is to assess the casualty’s breathing and look for signs of a tension pneumothorax (air accumulating in the pleural space, collapsing the lung). These include respiratory distress, absent breath sounds on one side, tracheal deviation (trachea shifting away from the injured side), and distended neck veins.

Management involves:

• Assess Airway, Breathing, and Circulation (ABCs): Check for breathing, pulse, and level of consciousness.
• Seal the Wound: Apply an occlusive dressing (e.g., petroleum gauze) over the wound to prevent air from entering the chest cavity. Ensure the dressing is airtight, taping it on three sides to allow air to escape if pressure builds up, preventing a tension pneumothorax.
• Needle Thoracostomy (if trained and resources allow): This advanced procedure involves inserting a needle into the chest cavity to relieve pressure from a tension pneumothorax. This is only performed by trained personnel.
• High-Flow Oxygen: Administer supplemental oxygen via a mask or non-rebreather mask.
• Monitor for Shock: Assess for signs of shock and manage as needed.
• Evacuation: Expedite evacuation to a higher level of care.

Remember, in a combat setting, quick actions to seal the wound and ensure adequate ventilation can dramatically increase the casualty’s chances of survival.

Suspected internal bleeding is a life-threatening condition. Immediate actions focus on controlling bleeding, maintaining circulation, and preventing shock.

• Control External Bleeding: Address any visible external bleeding immediately using direct pressure, pressure dressings, or tourniquets, as appropriate.
• Maintain Airway and Breathing: Ensure the airway is open and breathing is adequate.
• Position the Casualty: Place the casualty in the supine position (lying flat on their back) with legs slightly elevated to help blood flow back to the heart and brain.
• Monitor Vital Signs: Continuously monitor pulse, respiratory rate, skin color, and level of consciousness. A rapid, weak pulse, pale skin, and altered mental status are all signs of shock.
• Administer Oxygen: Supply high-flow oxygen if available.
• Rapid Evacuation: Internal bleeding requires immediate medical attention. Arrange for rapid transport to a medical facility.
• Keep Warm: Prevent hypothermia by keeping the casualty warm.

Internal bleeding can be subtle and require a high index of suspicion. Even without obvious external bleeding, a casualty with blunt trauma (e.g., a fall from a height) or penetrating trauma to the abdomen or chest should be treated for potential internal bleeding.

Treating a significant limb injury under austere conditions requires prioritizing stabilization and pain management while preparing for evacuation.

• Control Bleeding: Direct pressure, pressure dressings, and tourniquets (if necessary) are paramount to stop blood loss.
• Immobilization: Splint the injured limb to prevent further damage and reduce pain. Improvised splints using readily available materials (sticks, boards, etc.) may be necessary.
• Pain Management: Administer available analgesics (pain relievers) if possible. Even simple measures like proper positioning can offer comfort.
• Assess for Neurological Deficit: Check for sensation, movement, and circulation (pulses) distal to the injury site.
• Elevation: If possible, elevate the injured limb to reduce swelling.
• Evacuation: Arrange for immediate transport to a medical facility.

Example: Imagine a soldier with a broken femur sustained during a patrol. While a proper traction splint might not be available, using a makeshift splint from branches and securing it with cloth can significantly reduce pain and further injury before evacuation.

Airway management under stress is a crucial skill. My experience includes managing casualties in simulated and real-world scenarios with various levels of airway compromise, from simple airway obstruction to severe trauma.

Stress significantly impacts performance, so maintaining a calm and methodical approach is essential. I emphasize a systematic approach, ensuring proper positioning of the patient, effective airway maneuvers (jaw thrust, head tilt-chin lift – remembering potential spinal injuries), and the use of adjunctive devices such as oropharyngeal or nasopharyngeal airways when appropriate, always verifying effective ventilation.

Practicing under simulated stressful conditions, including limited resources and time pressure, allows for refinement of this critical skill. In one scenario, I successfully managed a casualty with an obstructed airway caused by a broken jaw in a mock combat setting, using improvised techniques under time pressure, highlighting the importance of maintaining situational awareness and adapting to unexpected challenges.

Hemorrhage, or bleeding, is categorized by the type of blood vessel affected:

• Arterial Bleeding: Bright red blood spurts rhythmically with each heartbeat. It’s the most life-threatening and requires immediate control with a tourniquet if direct pressure fails.
• Venous Bleeding: Dark red blood flows steadily. It is usually controlled with direct pressure and a pressure dressing.
• Capillary Bleeding: Oozing blood from small vessels, often controlled with direct pressure.

Control Techniques:

• Direct Pressure: Applying firm pressure directly to the wound, ideally with a sterile dressing, is the cornerstone of bleeding control. It works for most bleeds, except severe arterial bleeding where a tourniquet is necessary.
• Pressure Dressing: A dressing held in place with firm bandaging to maintain pressure on the wound.
• Tourniquet: Used for severe, uncontrolled arterial bleeding. It must be placed proximal (above) to the wound. Proper application and documentation are crucial; tourniquets should only be applied as a last resort because of potential complications.
• Elevation: Elevating the injured limb above the heart can help reduce swelling and slow bleeding, but it’s secondary to direct pressure.

Effective control of hemorrhage relies on recognizing the type of bleeding and using the appropriate technique promptly. Remember, time is critical; uncontrolled bleeding can quickly lead to death.

In a mass casualty incident (MCI), casualty prioritization is crucial because resources are limited. The START (Simple Triage And Rapid Treatment) method is commonly used.

START involves assessing casualties based on their respiratory status, perfusion (circulation), and mental status.

• Respiratory Status: Is the casualty breathing? If not, open the airway. If still not breathing, they are tagged as deceased (black).
• Perfusion: Check for radial pulse and capillary refill. A palpable radial pulse and capillary refill of less than 2 seconds are indicators of adequate perfusion. Absence of a radial pulse or refill greater than 2 seconds indicates poor perfusion.
• Mental Status: Is the casualty able to follow simple commands? Inability to follow commands suggests altered mental status.

Casualty Tagging (Simplified):

• Immediate (Red): Requires immediate attention; life-threatening injuries that can be corrected in the field (e.g., uncontrolled bleeding, compromised airway).
• Delayed (Yellow): Serious injuries, but not immediately life-threatening; can wait for treatment (e.g., open fractures, major burns).
• Minor (Green): Walking wounded; minimal injuries (e.g., minor lacerations, sprains).
• Deceased (Black): No respiration after airway intervention.

In a realistic MCI, triage would be a dynamic process constantly reevaluated as the situation changes.

Splinting fractures is crucial to prevent further injury and pain. The goal is to immobilize the broken bone and the joints above and below the fracture site. The type of splint used depends on the location and severity of the fracture, available resources, and the casualty’s condition.

• Rigid splints: These provide excellent immobilization and are ideal for most fractures. Examples include commercially available splints (like SAM splints), appropriately sized pieces of wood or metal, or even a sturdy piece of cardboard. Remember to pad the splint to prevent pressure sores.

• Soft splints: These are useful for injuries where a rigid splint might cause more harm, such as an already swollen or deformed limb. Soft splints can be improvised from rolled-up blankets, towels, or even clothing. The goal is to support the limb and prevent movement.

• Traction splints: These are specifically designed for femoral (thigh bone) fractures and are used to align the bone ends and reduce pain. Improvised traction splints are generally avoided due to the complexity and potential for harm if not applied correctly. Proper training is absolutely essential for using traction splints effectively and safely.

• Anatomical splints: This involves using the casualty’s own uninjured limb as a splint for the injured one, for example, taping an injured forearm to the uninjured forearm. This is only suitable in certain cases and should be used with caution.

In all cases, proper splinting techniques ensure that the splint is securely fastened, but not so tight as to restrict blood flow. Always check the distal pulse (pulse below the injury site) after splinting to ensure adequate circulation. Remember, splinting is a temporary measure until professional medical care can be provided.

Shock is a life-threatening condition where the body isn’t getting enough blood flow. There are several types, each requiring different management strategies.

• Hypovolemic shock: This is the most common type, caused by significant blood or fluid loss (e.g., from severe bleeding). Management focuses on controlling bleeding (direct pressure, tourniquets), replacing fluids (IV fluids if available), and keeping the casualty warm.

• Cardiogenic shock: This results from the heart’s inability to pump enough blood. Management requires advanced medical care and isn’t usually manageable in a field setting. Focus on basic life support until advanced care arrives.

• Neurogenic shock: Caused by damage to the nervous system, resulting in widespread blood vessel dilation. Management focuses on maintaining airway, breathing, and circulation. Fluid replacement may be necessary, but advanced medical intervention is usually required.

• Septic shock: This occurs due to a severe infection, leading to widespread inflammation and low blood pressure. Management includes treating the underlying infection with antibiotics (if available), fluid resuscitation, and supportive care.

• Anaphylactic shock: This is a severe allergic reaction. Management involves administering epinephrine (if available and the casualty has a known allergy), maintaining the airway, and supporting breathing and circulation.

Regardless of the type, the overall management of shock includes maintaining airway patency, administering oxygen, controlling bleeding, keeping the casualty warm, and monitoring vital signs. Rapid evacuation to definitive care is crucial.

Hypothermia is a dangerous drop in body temperature. Signs and symptoms range from shivering and confusion to unconsciousness and cardiac arrest. Early detection is crucial.

• Mild hypothermia: Shivering, cold skin, confusion, impaired judgment.

• Moderate hypothermia: Severe shivering, slurred speech, muscle stiffness, loss of coordination.

• Severe hypothermia: Absence of shivering, slow heart rate, slow breathing, loss of consciousness.

Field treatment focuses on gradual rewarming. Do not use direct heat, as this can cause cardiac arrhythmias. Instead, remove wet clothing, wrap the casualty in warm blankets, provide warm drinks (if conscious and able to swallow), and seek shelter from the elements. If the casualty is unconscious, focus on maintaining airway, breathing, and circulation and prioritize rapid evacuation to a medical facility.

Managing a head injury requires a systematic approach. The primary concern is to prevent further injury to the brain.

• Assessment: Check for consciousness (AVPU scale: Alert, Verbal, Pain, Unresponsive), breathing, and circulation. Assess for any obvious wounds, bleeding, or deformity.

• Airway management: Maintain a clear airway. If necessary, use a jaw-thrust maneuver to open the airway, avoiding neck movement.

• Bleeding control: Control any external bleeding with direct pressure.

• Immobilization: Immobilize the neck and spine using a cervical collar and backboard if available. Avoid unnecessary neck movement.

• Monitoring: Monitor vital signs regularly (breathing, pulse, blood pressure), level of consciousness, and pupil size. Look for signs of increasing intracranial pressure (e.g., decreased level of consciousness, altered breathing, widening pulse pressure).

Evacuate the casualty as quickly as possible to a medical facility. Never give the casualty anything by mouth unless specifically instructed by medical personnel.

Pain management in combat casualty care is critical. Uncontrolled pain can lead to increased stress, shock, and decreased cooperation. However, pain management must be balanced with the need to maintain alertness and awareness, particularly for situations requiring evacuation or further assessment.

In the field, pain management is often limited to non-narcotic analgesics like ibuprofen (if available) or simple comfort measures like splinting and elevating injured limbs. Opioids can be considered in severe cases if available and administered by properly trained personnel, understanding their potential side effects including respiratory depression. The key is judicious use, balancing pain relief with the casualty’s overall condition and the need for ongoing assessment and cooperation.

In a combat environment, priorities must be considered—effective pain management will improve the casualty’s chances of survival while allowing for efficient transportation and treatment. The availability of resources will significantly influence the approach chosen.

An open fracture exposes bone through a break in the skin, increasing the risk of infection. Management requires careful attention to wound care, fracture immobilization, and prevention of infection.

• Assessment: Assess the casualty’s overall condition (ABCs). Evaluate the wound for severity, bleeding, and contamination.

• Wound care: Control bleeding with direct pressure (avoiding direct pressure on the bone itself if possible). Clean the wound minimally with sterile saline if available. Don’t attempt to probe the wound or replace protruding bone.

• Immobilization: Carefully splint the fracture, ensuring the splint doesn’t contact the open wound. Cover the wound with a sterile dressing.

• Pain management: Administer pain relief as appropriate and available.

• Prophylactic antibiotics: If available and appropriate, prophylactic antibiotics may be administered to prevent infection. This decision should be guided by established protocols and medical advice when possible.

Rapid evacuation to definitive care is crucial to minimize the risk of infection and optimize healing.

IV fluid administration is a critical skill in combat casualty care, used to replace lost fluids, maintain blood pressure, and deliver medications. My experience involves the use of crystalloid solutions (like normal saline or lactated Ringer’s) in various field settings.

I am proficient in establishing IV access, selecting appropriate fluid types, and adjusting infusion rates based on the casualty’s condition. I understand the critical importance of sterile technique to prevent infection in a potentially contaminated environment. The limitations of fluid therapy in a combat setting, particularly the inability to measure central venous pressure, are well understood. Prioritization of interventions is essential, balancing IV fluid administration with other life-saving measures. My experience includes both supervised and independent administration of IV fluids, always adhering to established protocols and safety guidelines. Improvised fluid administration techniques are used only in situations where standard equipment is unavailable, and safety is paramount.

Maintaining sterile techniques in a combat environment is paramount to preventing infection, a major killer on the battlefield. Even seemingly minor wounds can become life-threatening if contaminated. Think of it like this: a small cut in a clean environment might heal quickly, but the same cut exposed to dirt, debris, and potentially contaminated water in a combat zone is a breeding ground for bacteria. This increases the risk of sepsis, a potentially fatal systemic infection.

Sterile techniques, while challenging to maintain perfectly in the chaos of combat, involve several key steps: using sterile gloves and dressings, avoiding touching sterile surfaces with unsterile hands, and minimizing the time a wound is exposed to the environment. We prioritize wound cleansing with appropriate solutions (povidone-iodine, for instance) and ensuring proper wound closure techniques to minimize further contamination. In short, we fight infection as hard as we fight the enemy.

Handling the psychological aspects of casualty care under pressure requires a combination of training, experience, and self-awareness. The stress of combat, the sights and sounds of injury, can be overwhelming for both the casualty and the medic. Maintaining composure is critical. I personally use a structured approach: Assess, Treat, Communicate. First, I focus on a quick but thorough assessment to prioritize immediate threats to life. Then, I act decisively on the treatment, providing reassurance and clear, concise instructions to the casualty as I work. Finally, I ensure communication to higher authorities concerning the casualty’s condition and next steps, removing any additional burden from my focus on the current task.

Moreover, practicing mindfulness techniques before deployment and recognizing the signs of stress in both myself and my team is crucial. We support each other, debrief after traumatic events, and use available mental health resources. Remember, taking care of the mental health of our team is just as essential as managing physical injuries.

My experience with medication administration in the field is extensive. It spans from the routine administration of analgesics (pain relievers) for managing mild to moderate pain, to the more complex administration of medications like intravenous fluids for managing shock or antibiotics for treating infections. I’m proficient in administering medications via various routes—oral, intramuscular, intravenous—and am acutely aware of the potential side effects and contraindications for each medication. This knowledge is crucial for making effective treatment decisions, particularly in austere environments where resource availability might be limited.

One specific example involves a casualty suffering from severe hypovolemic shock. Rapid intravenous fluid administration was crucial to stabilize their condition until more advanced medical care could be obtained. Precise calculations and meticulous monitoring were essential during this procedure. Accurate documentation, which is always critical, is especially vital in a combat setting where tracking medication administration can be crucial in determining subsequent treatment pathways.

While my training is extensive, it’s not exhaustive. There are limitations, and I’m honest about that. My training doesn’t cover every possible scenario – there will always be situations beyond my skill set. When faced with this, my approach is methodical and involves several key steps:

• Honest Self-Assessment: I immediately recognize the limits of my abilities.
• Prioritization: I focus on immediate life-threatening injuries first.
• Communication: I clearly communicate the situation to higher medical authorities or specialists, providing all relevant information to ensure the casualty receives appropriate care.
• Stabilization: I focus on stabilizing the casualty until more skilled help arrives, emphasizing basic life support and minimizing further harm.

Essentially, my training emphasizes not only what I *can* do, but also how to effectively manage situations where I need additional expertise. This involves effective communication and efficient teamwork.

Communicating with civilian medical personnel about a casualty’s condition requires clear and concise reporting using standardized medical terminology. I would use a structured approach such as the SBAR framework (Situation, Background, Assessment, Recommendation). This facilitates efficient handoff of care. For example, I might say something like:

“Situation: I have a 25-year-old male with a gunshot wound to the abdomen. He is conscious but exhibiting signs of hemorrhagic shock. Background: He was injured approximately 30 minutes ago in a firefight. Assessment: His blood pressure is 80/40, heart rate is 130, and he’s pale and diaphoretic. I’ve already administered two tourniquets and am providing IV fluids. Recommendation: I recommend immediate surgical intervention and blood transfusion.”

Clear communication prevents misunderstandings and ensures a smooth transition of care, ultimately improving the casualty’s chances of survival.

There are several types of tourniquets, each with its strengths and weaknesses. The choice depends on the specific situation and available resources. Common types include:

• RATS (Rapid Application Tourniquet System): A widely used, reliable, and easy-to-apply tourniquet, ideal for extremity trauma in a high-pressure environment.
• Combat Application Tourniquet (CAT): Another popular and effective tourniquet known for its ease of use and secure application. Provides a reliable method for limb exsanguination control.
• Emergency Tourniquet: These are often simpler, less adjustable tourniquets, better suited for situations with limited resources or time constraints. Their use is mainly considered as a last resort given less than ideal constriction.

We use tourniquets to control severe bleeding from extremity injuries, where the artery has been damaged severely. Applying a tourniquet is a high-stakes decision and should be used for uncontrolled bleeding only, as it restricts blood flow and may lead to tissue damage if left on for extended periods.

A chest seal is a specialized occlusive dressing used to treat open chest wounds (pneumothorax or sucking chest wounds). Improper use can be fatal. It creates an airtight seal over the wound, preventing air from entering the chest cavity and collapsing the lung. The proper use involves:

• Assessment: Identify the presence of an open chest wound with air entering the chest.
• Application: Apply the chest seal firmly over the wound, ensuring a complete and airtight seal. Any remaining air needs to be released.
• Monitoring: Monitor the patient closely for respiratory distress. If respiratory compromise is still present and a second chest seal is required it should be placed at least 4 inches from the first seal.

The limitations involve that a chest seal is only a temporary measure. It doesn’t address underlying injuries. If the wound is large or has significant bleeding, a chest seal alone won’t suffice. Furthermore, it’s essential to understand that improper application can worsen the condition, hence rigorous training is crucial.

Casualty evacuation is the process of moving wounded or injured personnel from a point of injury to a point of definitive medical care. It’s a critical component of combat first aid, and its success hinges on several principles. First and foremost is triage – prioritizing casualties based on the severity of their injuries and their likelihood of survival. Those with the most critical injuries needing immediate attention are moved first. Secondly, time sensitivity is paramount; rapid evacuation is essential to improve survival rates, especially for those with life-threatening injuries like massive hemorrhage or penetrating trauma. Thirdly, the method of evacuation needs to be selected based on the environment (terrain, accessibility), the casualty’s condition, and available resources. This could range from carrying the casualty on a litter, using a vehicle, or even utilizing a helicopter. Finally, safety for both the casualty and the evacuation team is vital. The entire process must be planned and executed with minimal risk of further injury.

For example, imagine a scenario where a soldier sustains a penetrating chest wound. Rapid evacuation, perhaps via helicopter, is prioritized over a casualty with a minor fracture, who might be moved by a more conventional method like a stretcher and ambulance once the critical cases are handled.

Resource prioritization in a limited supply situation is governed by a combination of ethical considerations and tactical realities. The mnemonic START (Simple Triage And Rapid Treatment) is extremely helpful. First, we categorize casualties by their immediate needs. Those requiring immediate intervention (e.g., severe bleeding, compromised airway) receive priority, even if it means temporarily delaying treatment for others with less urgent needs. Resources – such as tourniquets, IV fluids, and pain medication – are allocated accordingly. We use a tiered approach. The most severely injured receive the most resources first, with the goal being to stabilize them and improve their chances of survival. This might involve a difficult decision where we have only one tourniquet and must choose between two casualties with severe bleeding, selecting the one with the most immediate life threat. Continuous reassessment is crucial. As resources are consumed, the prioritization might shift depending on the evolving situation and available supplies. This necessitates effective communication amongst the medical team and leadership to ensure fairness and maximize survivability.

My experience in battlefield trauma management includes extensive training in advanced trauma life support (ATLS) techniques adapted for a tactical environment. This encompasses managing penetrating and blunt force trauma, hemorrhage control using tourniquets and other methods, airway management including the use of advanced airway adjuncts, and managing various types of shock. I’ve participated in numerous simulations and exercises, where we practice casualty evacuation under realistic scenarios, including limited resources and hostile environments. For example, during a simulation involving a mass casualty incident, I had to rapidly assess multiple casualties, prioritize those with life-threatening injuries, and delegate tasks to other medics effectively while working under extreme time pressure. This experience has equipped me to handle the complexities of battlefield trauma, emphasizing rapid assessment, efficient treatment, and effective teamwork.

The key differences between civilian and tactical emergency medical care lie primarily in the environment, the types of injuries encountered, and the constraints on resource availability and safety. In civilian EMS, the focus is primarily on stabilizing the patient and transporting them to a hospital. The environment is typically safe and resources are generally plentiful. Tactical medicine operates within a high-threat environment, such as a combat zone or active shooter situation, where personal safety is a primary concern. Injuries are often more severe and complex, such as blast injuries or penetrating wounds from firearms. Resource availability is often limited and evacuation routes may be precarious. Treatment must be tailored to the specific environment. This includes utilizing techniques that can be quickly and effectively applied under duress, using limited equipment, and prioritizing casualty movement to a safer location. For instance, civilian EMS might use an ambulance for transportation, but in a tactical setting, a hasty evacuation might involve carrying a casualty to a pick-up point under fire.

Maintaining proficiency in Combat First Aid requires a multifaceted approach. I regularly participate in advanced training courses and workshops that incorporate the latest advancements in trauma management. I also conduct regular skills refreshers, practicing procedures such as tourniquet application, wound packing, and airway management. Simulation exercises help maintain my skills under pressure and allows me to work through different scenarios. This includes participation in large-scale mass casualty drills to keep my skills sharp in high-pressure, time-sensitive situations. Moreover, I actively seek out opportunities to work alongside and learn from experienced medics and military personnel, exchanging knowledge and best practices. Staying current with relevant literature and research, especially journal articles detailing battlefield trauma management, is also crucial.

During a training exercise simulating a vehicle-borne improvised explosive device (VBIED) detonation, we were faced with multiple casualties suffering from severe blast injuries and burns. We were severely short of medical supplies and faced the challenge of prioritizing patients based on the severity and survivability of their injuries. I had to make the difficult decision to allocate the limited supply of IV fluids to a casualty with severe hemorrhagic shock over another with less critical but still significant injuries. This decision was incredibly stressful, but I based it on the knowledge that the casualty with hemorrhagic shock was at immediate risk of death, and the IV fluids were crucial to stabilize them for evacuation. The situation tested my decision-making skills under pressure, while also highlighting the critical need for improved resource allocation in such circumstances. The exercise underscored the importance of planning and communication in managing mass casualties, a key factor in such high-pressure scenarios.

Adapting treatment in a remote location requires a fundamental shift in approach. The principle of ‘doing the most good with the least’ becomes paramount. Treatment plans would have to be adapted to the scarcity of resources. For instance, instead of relying on advanced equipment, we would rely on basic first aid techniques such as improvised splints, pressure dressings made from readily available materials, and using readily available clean water for wound irrigation if sterile solutions aren’t available. We would need to prioritize injuries that threaten immediate life and limb. Evacuation strategies would need to account for the lack of immediate medical facilities; this might mean improvising stretchers and establishing temporary shelters to stabilize and prepare the casualty for a potentially long transport. Communication is key; I’d need to make sure I am effectively communicating the casualty’s status and resource requirements to any outside support. This might involve improvised radio communication or other methods depending on the circumstances.