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Martin Dempsey

Martin “Marty” Edward Dempsey (born March 14, 1952), is a retired United States Army general who served as the 18th chairman of the Joint Chiefs of Staff from October 1, 2011 until September 25, 2015, his ceremonial last day (de facto); in actuality, his last day was September 30, 2015 (de jure). He previously served as the 37th chief of Staff of the Army from April 11, 2011, to September 7, 2011. Before that, he served as Commanding General, U.S. Army Training and Doctrine Command, from December 8, 2008, to April 11, 2011, as Acting Commander, U.S. Central Command, from March 24, 2008, to October 30, 2008, as Deputy Commander, U.S. Central Command, from August 2007 to March 23, 2008, and as Commanding General, Multi-National Security Transition Command – Iraq (MNSTC-I), from August 2005 to August 2007. Dempsey assumed his assignment as Chairman of the Joint Chiefs of Staff on October 1, 2011 and stepped down from the Chairmanship on September 25, 2015. He has served as a professor at Duke University and as chairman of USA Basketball.

Early life
Dempsey was born on March 14, 1952, in Jersey City, New Jersey, and grew up in nearby Bayonne. He attended John S. Burke Catholic High School in Goshen, New York. Dempsey is Irish American. Following high school, Dempsey attended the United States Military Academy at West Point and graduated with the Class of 1974. Dempsey's four grandparents were born in the counties of Sligo, Donegal, Mayo and Roscommon in Ireland. He learned a small amount of the Irish language while spending his summers in Ireland as a child.

Career
Dempsey received a commission as an Armor officer upon graduation from the United States Military Academy in 1974. As a company-grade officer, he served in 1st Squadron, 2d Armored Cavalry Regiment as the officer in charge for personnel. He went on to be the executive officer of the 3rd Brigade 3rd Armored Division during Operation Desert Shield/Storm. As a captain, Dempsey was the commanding officer of Alpha Troop, 1/10 Armored Cavalry at Ft. Carson, CO. As a lieutenant colonel he commanded the 4th Battalion of the 67th Armored Regiment "Bandits" from 1992 to 1995 in the 1st Armored Division in Friedberg, Hesse, Germany.

In 1996 he took command of the 3d Armored Cavalry Regiment. Following that assignment as the Army's “senior scout,” he served as an Assistant Deputy Director for Strategic Plans and Policy (J-5) on the Joint Staff, and as Special Assistant to the Chairman of the Joint Chiefs of Staff, General Henry H. Shelton, USA. During this period of his career, he attended both the Army Command and General Staff College and the National War College, earning master's degrees in military art and national strategic studies.

Promoted to brigadier general in August 2001, Dempsey first served in the Kingdom of Saudi Arabia training and advising the Saudi Arabian National Guard.

In June 2003, then Major General Dempsey assumed command of the 1st Armored Division. He succeeded Ricardo S. Sanchez who was promoted to lieutenant general, as commander of V Corps. Dempsey's command of the 1st Armored Division lasted until July 2005 and included 13 months in Iraq, from June 2003 to July 2004. While in Iraq, 1st Armored Division, in addition to its own brigades, had operational command over the 2nd Armored Cavalry Regiment and a brigade of the 82nd Airborne Division; the command, called "Task Force Iron" in recognition of the Division's nickname, "Old Ironsides", was the largest division-level command in the history of the United States Army.

It was during this time that the U.S. intervention in Iraq changed dramatically as Fallujah fell to Sunni extremists and supporters of Muqtada al-Sadr built their strength and rose against American forces. Then Major General Dempsey and his command assumed responsibility for the area of operations in Baghdad as the insurgency incubated, grew, and exploded. General Dempsey has been described by Thomas Ricks in his book "Fiasco": "In the capital itself, the 1st Armored Division, after Sanchez assumed control of V Corps, was led by Maj. Gen. Martin Dempsey, was generally seen as handling a difficult (and inherited) job well, under the global spotlight of Baghdad."

On March 27, 2007, Lieutenant General Dempsey was transferred from commander of Multi-National Security Transition Command-Iraq, and reassigned as deputy commander of U.S. Central Command at MacDill Air Force Base, Florida.

On February 5, 2008, Dempsey was nominated to head the U.S. Army, Europe/Seventh Army, and was nominated for promotion to four-star general upon Senate approval.

On March 11, 2008, Dempsey's commander, Admiral William J. Fallon, resigned from his post as commander of Central Command. U.S. Secretary of Defense Robert Gates accepted this as effective on March 31. Dempsey temporarily took over as acting commander.

On March 13, 2008, Dempsey was confirmed by the United States Senate as Commander, U.S. Army, Europe/Seventh Army. However, due, to Admiral Fallon's unexpected retirement, Dempsey never took command of U.S. Army, Europe/Seventh Army.

On July 11, 2008, Dempsey was nominated to take command of U.S. Army Training and Doctrine Command while Lieutenant General Carter F. Ham replaced his nomination to command the U.S. Army, Europe/Seventh Army.

On December 8, 2008, Dempsey assumed command of United States Army Training and Doctrine Command.

On January 6, 2011, Defense Secretary Robert Gates announced that he would recommend that the President nominate General Dempsey to succeed General George Casey as the Army Chief of Staff. On February 8, 2011, Gates announced that President Barack Obama nominated Dempsey to be the 37th Chief of Staff of the United States Army. On March 3, 2011, Dempsey testified before the United States Senate Committee on Armed Services, and on March 15, 2011, the committee affirmatively reported Dempsey's nomination. On March 16, 2011, the Senate confirmed Dempsey's nomination by unanimous consent. On April 11, 2011, Dempsey was sworn in as Chief of Staff of the United States Army at a ceremony at Fort Myer.

With Admiral Michael Mullen set to retire as Chairman of the Joint Chiefs of Staff in September 2011, U.S. President Obama needed to select his replacement. The vice-chairman, Marine General James Cartwright, who was initially believed to be the front runner for the job, had fallen out of favor among senior officials in the Defense Department. Obama administration officials revealed on May 26, 2011, that the President would nominate Dempsey to the post of chairman. In August 2011, General Dempsey was confirmed by unanimous consent to succeed Admiral Mike Mullen as the next chairman of the Joint Chiefs of Staff. He was sworn in as 18th chairman of the Joint Chiefs of Staff on October 1, 2011. On June 26, 2013, President Barack Obama re-nominated General Dempsey to serve a second two-year term as chairman. Dempsey stepped down on September 25, 2015, and was replaced by General Joseph Dunford, USMC.

Dempsey was appointed as the chairman of USA Basketball for a term between 2017 and 2020, and is an NBA representative.

On October 18, 2020, Dempsey was inducted into the New Jersey Hall of Fame, in the Public Service category.

Personal life
Dempsey is married to his high school sweetheart, Deanie. They have three children: Chris, Megan, and Caitlin. Each has served in the United States Army and is married with three children. Chris remains on active duty as a cavalry colonel. Martin and Deanie have nine grandchildren.

Education

 * 1974 Bachelor of Science degree, U.S. Military Academy, West Point, New York
 * 1984 Master of Arts degree in English, Duke University, Durham, North Carolina
 * 1988 Master of Military Art and Science degree, United States Army Command and General Staff College
 * 1995 Master of Science degree in national security and strategic studies, National War College

Awards and decorations
On December 7, 2011, Dempsey received the USO's Distinguished Service Award on behalf of all military members. In October 2016, he was made an honorary Knight Commander of the Order of the British Empire by Queen Elizabeth II, for commitment to British-American defense cooperation. Also, the Association of the United States Army, on October 17, 2019 awarded Dempsey the George Catlett Marshall Medal for distinguished public service, that organization's highest award.

Interviews

 * 1) Dempsey Muses on Challenges as New Head of Joint Chiefs – Thom Shanker. New York Times. Oct 3, 2011.
 * 2) The New Chairman of the Joint Chiefs of Staff on "Getting to the Truth" – Karl Moore. Forbes Magazine. Oct 20, 2011.
 * 3) Gen. Martin Dempsey's Interview with Jeremy Paxman – Jeremy Paxman, BBC. Nov 28, 2011.
 * 4) Transcript: Gen. Martin Dempsey's Interview with Fareed Zakaria – Fareed Zakaria. CNN. Feb 19, 2012.
 * 5) Video: Gen. Martin Dempsey's Interview with Charlie Rose – Charlie Rose. Mar 16, 2012.
 * 6) Video: Gen. Martin Dempsey's Interview on Leadership – The Pentagon Channel. October 2012.
 * 7) Video: Gen. Martin Dempsey at the National Press Club – National Press Club. October 10, 2012.
 * 8) Transcript: Gen. Martin Dempsey talks to Dan Rather – Dan Rather Reports. AXS.tv. November 13, 2012.
 * 9) Transcript: Gen. Martin Dempsey talks to Ted Koppel – Rock Center with Brian Williams. NBC. January 24, 2013.
 * 10) Transcript: Sec. Panetta & Gen. Dempsey's Interview with Candy Crowley – State of the Union. CNN. February 3, 2013.
 * 11) Transcript: Sec. Panetta & Gen. Dempsey's Interview with Chuck Todd – Meet the Press. NBC. February 3, 2013.
 * 12) Transcript: Gen. Martin Dempsey talks to Rachel Martin – Weekend Edition. NPR. February 17, 2013.
 * 13) Transcript: Gen. Martin Dempsey talks to Candy Crowley – State of the Union. CNN. July 7, 2013.
 * 14) Transcript: Gen. Martin Dempsey talks to Martha Raddatz – This Week. ABC. August 4, 2013.
 * 15)  Transcript: Gen. Martin Dempsey talks to Steve Inskeep - NPR. Morning Edition. June 4, 2020.

Speeches

 * 1) Gen. Dempsey Becomes the 18th Chairman of the Joint Chiefs of Staff – September 30, 2011
 * 2) The Atlantic Council of the United States: Security and Partnership in an Age of Austerity – December 9, 2011.
 * 3) End of Mission Ceremony in Baghdad, Iraq – December 15, 2011.
 * 4) Duke University's Ambassador S. Davis Phillips Family International Lecture Series: A New Vision for the US Military – January 12, 2012.
 * 5) West Point Class of 2013 500th Night – January 21, 2012.
 * 6) Harvard University's John F. Kennedy Jr. Forum: Security Paradox – April 12, 2012.
 * 7) The Carnegie Endowment for International Peace: A Conversation with General Martin Dempsey – May 1, 2012.
 * 8) Kansas State University's 161st Landon Lecture – October 1, 2012

title: Martin Dempsey


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Laurence Henry Hicks

Laurence Henry Hicks OBE (1912 – 21 April 1997) was an English-born military bandmaster and composer. He migrated to Australia in 1952 after having served in World War II with both the British Army's Black Watch and the Fourth Canadian Armoured Division's military bands. From April 1952 onward, Hicks was the first Director of Music for the Royal Australian Air Force (RAAF). On 1 January 1963, he was appointed to The Order of the British Empire – Officer (Military) with the citation, "For service as Director of Music with the RAAF". In preparation for the 1968 independence of Nauru, Hicks composed music for the national anthem "Nauru Bwiema", with lyrics by Nauruan writer Margaret Hendrie. He was Squadron Leader of the Central Band which performed on 31 January at the independence ceremony in Nauru.

Biography
Laurence Hicks was born in 1912 in London to a father who was a clarinet player in the British Army. At the age of 14 years, he was a band boy for the Cameronian Scottish Rifles. The following year he attended Royal Military School of Music at Kneller Hall learning the clarinet and cello. He subsequently joined the Cameronian Scottish Rifles as a clarinetist and toured Egypt for two years and then India. He returned to study at Kneller Hall undertaking a bandmaster course and graduated in 1938. Hicks was appointed to the Black Watch and served with them at the outset of World War II. From 1940 to 1941 he taught woodwind instruments at Kneller Hall. The following year, he trained a military band for the Canadian Army, and in 1944 took part in the allied invasion of Europe with the Fourth Canadian Armoured Division. In mid-June 1944, the Royal Canadian Ordnance Corps Band performed at Normandy, Hicks recalled "we were mobbed by the troops particularly after we played the 'Colonel Bogey March' which everyone enjoyed". After the war he rejoined the Black Watch band and performed in India, Germany, Denmark, Sweden and Britain.

In January 1951, his band recorded Black Watch Military Band (Royal Highland Regiment) Conducted by Bandmaster Laurence H. Hicks, which included a composition by Hicks, "Jubilee March". The following month they toured Australia and New Zealand. In April 1952 he was appointed the inaugural Director of Music for the Royal Australian Air Force (RAAF) and re-established the Central Band. He recruited new members and designed the band's uniform. By March 1956 the Central Band were practising every national anthem for the forthcoming Summer Olympics in Melbourne. On 1 January 1963, Hicks was awarded The Order of the British Empire – Officer (Military), "in recognition of his loyal and valuable service", with the citation "For service as Director of Music with the RAAF".

In preparation for the 1968 independence of Nauru, Hicks composed music for the national anthem, "Nauru Bwiema", with lyrics by Nauran writer, Margaret Hendrie. He was Squadron Leader of the RAAF Central Band which performed on 31 January at the independence ceremony in Nauru.

In about 1938, Hicks married and by 1956 the couple had three children. Hicks died in 1997 aged 84-85, and in 1998, the Nauru Philatelic Bureau issued stamps to commemorate the 30th year of independence, including two acknowledging Hicks role.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Laurence Henry Hicks


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Scripophily

Scripophily is the study and collection of stock and bond certificates. A specialized field of numismatics, scripophily has developed as an area of collecting because of the inherent beauty of certain historical certificates, and because of interest in the historical context of many of the documents. In addition, some stock certificates serve as excellent examples of engraving. Occasionally, an old stock certificate is found that still has value, representing actual shares in the original or a successor company.

History
Scripophily, the collecting of old stocks and bonds, gained recognition as a hobby around 1970. The word "scripophily" was coined by combining words from English and Greek. The word "scrip" represents an ownership right and the word "philos" means "to love".

Today, there are thousands of collectors worldwide in search of scarce, rare, and popular stock and bond certificates. Whether they are private investors or business people, many collectors enjoy scripophily as a hobby, while others consider it a good form of investment.

Many collectors appreciate the historical significance of old certificates. Others prefer the beauty of older stock and bond certificates that were printed in various colors with fancy artwork and ornate engravings. In recent times, certificates issued by dot-com companies and companies involved in scandals have become particularly popular amongst scripophilists.

A recent addition to the hobby of scripophily is collecting shares issued in one's name. Common companies that issue personalized stock certificates include The Walt Disney Company, Harley-Davidson, McDonald's, Starbucks, Google, Ford Motor Company, The Coca-Cola Company, and Berkshire Hathaway.

Many autograph collectors engage in scripophily, looking for certificates signed by historic or well-known figures. Certificates of this type include stock certificates issued by Standard Oil Company and signed by John D. Rockefeller, Franklin Fire Insurance Company certificates signed by Henry Charles Carey, Ringling Brothers and Barnum & Bailey Circus, Atari Corporation, Eastern Air Lines certificates signed by Eddie Rickenbacker when he served as the company's president, Tucker Corporation, and many others.

As a hobby
A large part of scripophily is the study of financial history. Over the years there have been millions of companies that needed to raise money. In order to do so, the founders of these companies issued securities. Generally speaking, they either issued equity securities in the form of stock or debt securities in the form of bonds. However, there are many varieties of equity and debt instruments, including common stock, preferred stock, warrants, and bonds of various types.

Each certificate is a piece of history about a company and its business. Some companies became major successes, while others were acquired and merged with other companies. Some companies and industries were successful until they were replaced by new technologies. Some companies have been the center of scandal or fraud. The color, paper, signatures, dates, stamps, cancellations, borders, pictures, vignettes, industry, stockbroker, name of company, transfer agent, printer, and holder name are all of interest to scripophilists.

Many companies either were never successful or went bankrupt, so that their certificates became worthless pieces of paper until the hobby of scripophily began. The mining boom in the 1850s, railroad construction in the 1830s, the oil boom in the 1870s, telegraphy in the 1850s, the automobile industry beginning around 1900, aviation beginning around 1910, electric power and banks in the 1930s, the airline wars and mergers in the 1970s, cellular telephones beginning in the 1980s, long-distance telephone service in the 1980s and 1990s, and most recently the dot-com era and Enron all resulted in historically significant certificates being generated and issued.

Today, stocks and bonds are typically issued electronically, meaning fewer paper certificates are issued as a percentage of actual stock issued. The Internet has played a role in raising awareness of the hobby. A number of websites now exist that sell old stocks and bonds.

Guidelines
There are many factors that determine value of a certificate. These include condition, age, historical significance, signatures, rarity, demand for the item, aesthetics, the type of company, the original face value, bankers associated with the issuance, transfer stamps, cancellation markings, whether the certificate was issued or unissued, printers, and the type of engraving process.

title: Scripophily


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Hicks (disambiguation)

Hicks is a surname.

Hicks may also refer to:

 * Hicks, Louisiana, an unincorporated community
 * Hicks, Ohio, an unincorporated community
 * Hicks City, Missouri, an unincorporated community
 * Hicks Island (New York)
 * Hicks Island, Australia
 * HM Capital Partners, a private US equity firm, formerly "Hicks, Muse, Tate & Furst"

title: Hicks (disambiguation)


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Battlefield medicine

Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.

Chronology of battlefield medical advances

 * During Alexander the Great’s military campaigns in the fourth century BC, tourniquets were used to stanch the bleeding of wounded soldiers. Romans used them to control bleeding, especially during amputations. These tourniquets were narrow straps made of bronze, using leather only for comfort.
 * An early stretcher, likely made of wicker over a frame, appears in a manuscript from c.1380. Simple stretchers were common with militaries right through the middle of the 20th century.
 * After being wounded during the Battle of Shrewsbury in 1403, Prince Henry had an arrow removed from his face using a specially designed surgical instrument.
 * Ambulances or dedicated vehicles for the purpose of carrying injured persons were first used by Spanish soldiers during the Siege of Málaga (1487).
 * French military surgeon Ambroise Paré (1510–90) pioneered modern battlefield wound treatment. His two main contributions to battlefield medicine are the use of dressing to treat wounds and the use of ligature to stop bleeding during amputation.
 * The practice of triage, pioneered by Dominique Jean Larrey during the Napoleonic Wars (1803–1815). He also pioneered the use of ambulances in the midst of combat ('ambulances volantes', or flying ambulances). Prior to this, military ambulances had waited for combat to cease before collecting the wounded by which time many casualties would have succumbed to their injuries.
 * Russian surgeon Nikolay Ivanovich Pirogov was one of the first surgeons to use ether as an anaesthetic in 1847, as well as the very first surgeon to use anaesthesia in a field operation during the Crimean War.
 * American Civil War surgeon Jonathan Letterman (1824–72) originated modern methods of medical organization within armies.
 * The Relief Society for Wounded Soldiers, forerunner of the International Committee of the Red Cross (ICRC) was founded in 1863 in Geneva. The ICRC advocated for the establishment of national aid societies for battlefield medical relief, and stood behind the First Geneva Convention of 1864 which provided neutrality for medics, ambulances, and hospitals.
 * In the late 19th century, the influence of notable medical practitioners like Friedrich von Esmarch and members of the Venerable Order of Saint John pushing for every adult man and woman to be taught the basics of first aid eventually led to institutionalised first-aid courses amongst the military and standard first-aid kits for every soldier.
 * Advances in surgery - especially amputation - during the Napoleonic Wars and First World War on the battlefield of the Somme.
 * Medical advances also provided kinder methods for treatment of battlefield injuries, such as antiseptic ointments, which replaced boiling oil for cauterizing amputations.
 * During the Spanish Civil War there were two major advances. The first one was the invention of a practical method for transporting blood. Developed in Barcelona by Duran i Jordà, the technique mixed the blood of the donors with the same blood type and then, using Grífols glass tubes and a refrigerator truck, transported the blood to the frontline. A few weeks later Norman Bethune developed a similar service. The second advance was the invention of the mobile operating room by the Catalan Moisès Broggi, who worked for the International Brigades.
 * The establishment of fully equipped and mobile field hospitals such as the Mobile Army Surgical Hospital was first practiced by the United States in World War II. It was succeeded in 2006 by the Combat Support Hospital.
 * The use of helicopters as ambulances, or MEDEVACs, was first practiced in Burma in 1944. The first MEDEVAC under fire was done in Manila in 1945 where over 70 troops were extracted in five helicopters, one and two at a time.
 * The extension of emergency medicine to pre-hospital settings through the use of emergency medical technicians.
 * The use of remote physiological monitoring devices on soldiers to show vital signs and biomechanical data to the medic and MEDEVAC crew before and during trauma. This allows medicine and treatment to be administered as soon as possible in the field and during extraction. Similar telemetry units are used in crewed spaceflight, where a flight surgeon at the Command Center can monitor vital signs. This can help to see issues before larger problems occur, such as elevated carbon dioxide levels, or a rise in body temperature indicating a possible infection.

History of Tactical Combat Casualty Care (TCCC)
In 1989, the Commander of the Naval Special Warfare Command (NAVSPECWARCOM) established a research program to conduct studies on medical and physiologic issues. The research concluded that extremity hemorrhage was a leading cause of preventable death in the battlefield. At that time, proper care and treatment was not provided immediately which often resulted in death. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences. Through this 3-year research, the first version of the TCCC guidelines were created to train soldiers to provide effective intervention on the battlefield. The TCCC aims to combine good medicine with good small-unit tactics. One very important aspect that the TCCC outlined was the use of tourniquets, initially there was a belief that the use of tourniquets led to the preventable loss of an extremity due to ischemia but after careful literature search the committee arrived at the conclusion that there was not enough information out there to confirm this claim. The TCCC therefore outline the appropriate usage of tourniquets to provide effective first aid on the battlefield.

After the TCCC article was published in 1996, the program undertook 4 parallel efforts during the next 5-year period. These efforts are as follows:

 * 1) Presenting TCCC concepts to senior Department of Defense (DoD) line and medical leaders and advocating for their use.
 * 2) Identifying and developing responses to representative types of TCCC casualty scenarios.
 * 3) Initiating TCCC’s first strategic partnership with civilian trauma organizations—the Prehospital Trauma Life Support (PHTLS) Committee, the National Association of Emergency Medical Technicians (NAEMT), and the American College of Surgeons Committee on Trauma (ACS-COT).
 * 4) Expanding TCCC training beyond medical personnel to include SEAL and 75th Ranger Regiment combat leaders and nonmedical unit members.

Current applications of battlefield medicine
Over the past decade combat medicine has improved drastically. Everything has been given a complete overhaul from the training to the gear. In 2011, all enlisted military medical training for the U.S. Navy, Air Force, and Army were located under one command, the Medical Education and Training Campus (METC). After attending a basic medical course there (which is similar to a civilian EMT course), the students go on to advanced training in Tactical Combat Casualty Care.

Tactical combat casualty care (TCCC)
Tactical combat casualty care is becoming the standard of care for the tactical management of combat casualties within the Department of Defense and is the sole standard of care endorsed by both the American College of Surgeons and the National Association of EMT's for casualty management in tactical environments.

Tactical combat casualty care is built around three definitive phases of casualty care:
 * 1) Care Under Fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic. This stage focuses on a quick assessment, and placing a tourniquet on any major bleed.
 * 2) Tactical Field Care: Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours.  Care here may include advanced airway treatment, IV therapy, etc. The treatment rendered varies depending on the skill level of the provider as well as the supplies available.  This is when a corpsman/medic will make a triage and evacuation decision.
 * 3) Tactical Evacuation Care (TACEVAC): Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.

Since "90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility" (Col. Ron Bellamy) TCCC focuses training on major hemorrhaging and airway complications such as a tension-pneumothorax. This has driven the casualty fatality rate down to less than 9%.

Interventions used
Listed below are interventions that a TCCC provider may be expected to perform depending on the phase of TCCC they are at and their level of training. This list is not comprehensive and may be subject to change with future revisions in TCCC guidelines.

Hemorrhage control interventions include the use of extremity tourniquets, junctional tourniquets, trauma dressings, wound packing with compressed gauze and hemostatic dressings, and direct pressure. Newer devices approved for use by the CoTCCC for hemorrhage control include the iTClamp and XStat. Pharmacological options also include tranexamic acid, and hemostatic agents such as zeolite and chitosan.

In managing a casualty’s airway, a TCCC provider may position the casualty in the recovery position or utilize airway adjuncts such as nasopharyngeal airways, oropharyngeal airways, and supraglottic airways. They may also utilize the jaw thrust and head-tilt/ chin-lift maneuver to open a casualty's airway. Advanced TCCC providers may also perform endotracheal intubation and cricothyroidotomy.

Respiratory management largely revolves around the use of chest seals, vented and unvented, and needle decompressions to manage tension pneumothoraxes.

In circulation management a TCCC provider may obtain intravenous/ intraosseous access for the administration of fluids such as normal saline, lactated Ringer’s solution, whole blood, and colloids and plasma substitutes for fluid resuscitation. This also provides a route for the administration of other drugs in accordance with the provider’s scope of practice.

Head injuries would indicate for cervical spine immobilization to the best of the provider’s abilities if deemed appropriate in a given setting, or the use of devices such as a cervical collar.

As trauma-induced hypothermia is a leading cause of battlefield deaths, a provider may also perform hypothermia prevention can be accomplished through the use of a Hypothermia Prevention and Management Kit or emergency blanket, the placement of a casualty on an insulated surface, and the removal of wet clothing from a casualty’s body.

Care under fire
Care under fire is care provided at the point of injury immediately upon wounding while the casualty and care provider remain under effective hostile fire. The casualty should be encouraged to provide self-aid and continue remain engaged in the firefight if possible. If unable to do so, the casualty should be encouraged to move behind cover or "play dead". Due to the high risk of injury to the care-provider and limited resources at this phase, care provided to the casualty should be limited to controlling life-threatening hemorrhage with tourniquets and preventing airway obstruction by placing casualty in the recovery position. The primary focus during care under fire should be winning the firefight to prevent further casualties and further wounding of existing casualties.

Tactical field care
Tactical field care phase begins when the casualty and care-provider are no longer under imminent threat of injury by hostile actions. Though the level of danger is lessened, care-providers should exercise caution and maintain good situational awareness as the tactical situation may be fluid and subject to change. The tactical field care phase enables the provision of more comprehensive care according to care providers' levels of training, tactical considerations, and available resources. Major tasks that are to be completed in the tactical field care phase include the rapid trauma survey, the triage of all casualties, and the transport decision.

Tactical evacuation care
Tactical evacuation care refers to care provided when a casualty is being evacuated and en-route to higher levels of medical care. Care providers at this phase are at even less risk of imminent harm as result of hostile actions. Due to improved access to resources and the tactical situation, more advanced interventions can be provided to casualties such as endotracheal intubation. Patient re-assessments and the addressing of issues that were not or were inadequately addressed previously are also major components of this phase.

In tactical evacuation (TACEVAC), casualties are moved from a hostile environment to a safer and more secure location to receive advanced medical care. Tactical evacuation techniques use a combination of air, ground and water units to conduct the mission depending on the location of the incident and medical centres. Ground vehicle evacuations are more prevalent in urban locations that are in close proximity to medical facilities. Requests for evacuation of casualties and pertinent information are typically communicated through 9-Line MEDEVAC and MIST reports.

Tactical evaluation is an umbrella term that encompasses both medical evacuation (MEDEVAC) and casualty evacuation (CASEVAC). Medical evacuation platforms are typically not engaged in combat except in self-defence and defence of patients. MEDEVAC takes place using special dedicated medical assets marked with a red cross. Casualty evacuation is through non-medical platforms and may include a Quick-Reaction force aided by air support.

For aircraft involved TACEVAC situations there are many considerations that need to be accounted for. Firstly, the flying rules vary widely depending on the aircraft and units in play. The list of determinants to create the TACEVAC strategy include the distances and altitudes involved, time of day, passenger capacity, hostile threat, availability of medical equipment/personnel, and icing conditions. As mentioned TACEVAC is more advanced than TCCC, it also includes training to/for:

 * improve breathing
 * provide supplemental oxygen
 * administer Tranexamic acid (TXA)
 * deal with traumatic brain injuries
 * fluid resuscitation
 * blood product administration
 * blood transfusion
 * preventing and treating hypothermia

Canadian armed forces
There are three levels of tactical combat casualty care providers in the Canadian Armed Forces.

Combat first aid
Every soldier receives a two-day combat first aid training course. The course focuses on treating hemorrhages, using tourniquets and applying dressings, and basic training for casualty management.

Tactical combat casualty care
A select number of soldiers are chosen to participate in an intense 2-week tactical combat casualty care course where soldiers are provided with additional training. Overall, they are trained to work as medic extenders since they work under the direction of medics.

Tactical medicine
The tactical medicine (TACMED) course is offered exclusively to medics. The tactical medicine program provides training for advanced tactical combat casualty care and is the highest level of care provided by the Canadian Armed Forces in a battlefield setting. Medics are trained to treat and manage patients using the MARCHE protocol. The MARCHE protocol prioritizes potential preventable causes of death in warfare as follows:

 * 1) Massive hemorrhage control
 * 2) Airway management
 * 3) Respiratory management
 * 4) Circulation
 * 5) Bleeding control
 * 6) Intravenous (IV)/ intraosseous (IO) access
 * 7) Fluid resuscitation
 * 8) Tourniquet reassessment
 * 9) Hypothermia prevention
 * 10) Head injuries
 * 11) Eye injuries
 * 12) Everything else
 * 13) Monitor patient
 * 14) Pain management
 * 15) Head-to-toe assessment
 * 16) Address all wounds found
 * 17) Antibiotics
 * 18) Tactical evacuation preparation
 * 19) Documentation of care and findings

Care under fire
Care under fire happens at the point of injury. According to tactical combat casualty care guidelines, the most effective way to reduce further morbidity and mortality is to return fire at enemy combatants by all personnel. The priority is to continue the combat mission, gain fire superiority, and then treat casualties. The only medical treatment rendered in care under fire is the application of direct pressure on massive bleeding. Tactical combat casualty care recommends a tourniquet as the single most important treatment at the point of injury. It is recommended during care under fire to quickly place tourniquets over clothing, high, and tight; the tourniquet should be reassessed when out of danger in the tactical field care phase.

Tactical field care
Tactical field care is considered to be the backbone of Tactical Combat Casualty Care and consists of care rendered by first responders or prehospital medical personnel while still in the tactical environment. The acronyms MARCH and PAWS help personnel remember crucial treatment steps while under duress.

MARCH
The MARCH acronym is used by personnel to remember the proper order of treatment for casualties.

Massive hemorrhage. The most potentially survivable cause of death is hemorrhage from extremity bleeds, however more than 90% of 4596 combat mortalities post September 11, 2001 died of hemorrhage associated injuries. It is recommended to apply a Committee on Tactical Combat Casualty Care (CoTCCC) approved tourniquet for any life-threatening extremity hemorrhages. Tourniquets during tactical field care should be placed under clothing 2 to 3 inches above the wound, with application time written on the tourniquet.

Airway. Non-patent or closed airway is another survivable cause of death. Airway injuries typically occur due to inhalation burns or maxillofacial trauma. If a person is conscious and speaking they have a patent open airway, while nasopharyngeal airway could benefit those who are unconscious and breathing. However, unconscious casualties who are not breathing could require surgical cricothyroidotomy, as endotracheal intubation is highly difficult in tactical settings.

Respirations. Tension pneumothorax (PTX) develops when air trapped in the chest cavity displaces functional lung tissue and puts pressure on the heart causing cardiac arrest. Thus, open chest wounds must be sealed using a vented chest seal. Tension pneumothorax should be decompressed using a needle chest decompression (NCD) with a 14 gauge, 3.25 inch needle with a catheter. Ventilation and/or oxygenation should be supported as required.

Circulation. It is more important to stem the flow of bleeding than to infuse fluids, and only casualties in shock or those who need intravenous (IV) medications should have IV access. Signs of shock include unconsciousness or altered mental status, and/or abnormal radial pulse. IV should be applied using an 18 gauge catheter and saline lock in tactical field care, secured by transparent would-dressing film. Tranexamic acid (TXA) should be given as soon as possible to casualties in or at risk of hemorrhagic shock. An intraosseous (IO) device could also be used for administering fluids if IV access is not feasible.

Head injury/hypothermia. Secondary brain injury is worsened by hypotension (systolic blood pressure under 90 mmHg), hypoxia (peripheral capillary oxygen saturation under 90%), and hypothermia (whole body temperature below 95 Fahrenheit or 35 Celsius). Medical personnel can use the Military Acute Concussion Evaluation (MACE), while non-medical personnel can use the alert, verbal, pain, unresponsive (AVPU) scale to identify traumatic brain injury. The "lethal triad" is a combination of hypothermia, acidosis, and coagulopathy in trauma patients. Since hypothermia can occur regardless of ambient temperature due to blood loss, the Hypothermia Prevention and Management Kit (HPMK) is recommended for all casualties.

PAWS
The PAWS acronym is used by personnel to remember additional casualty care items that should be addressed.

Pain. Proper management of pain reduces stress on a casualty's mind and body, and have reduced incidents of post-traumatic stress disorder (PTSD). Pain management is shown to reduce harmful patient movement, improves compliance and cooperation, and allows for easier transport as well as improved health outcomes.

Antibiotics. All battlefield wounds are considered contaminated, and thus any penetrating injury should receive antibiotics at the point of injury as well as in tactical field care. The recommended parenteral antibiotics are 1g ertapenem or 2g cefotetan, which can treat multi drug-resistant bacteria. if the casualty can tolerate oral fluids, 400mg moxifloxacin can be administered orally instead of ertapenem or cefotetan.

Wounds. Assessing the casualty for additional wounds improves morbidity and mortality. First responders must address burns, open fractures, facial trauma, amputation dressings, and security of tourniquets. Prior to movement, reassessment of wounds and interventions is very important. Casualties with penetrating trauma to the chest or abdomen should receive priority evacuation due to the possibility of internal hemorrhage.

Splinting. Explosions (such as from improvised explosive device or land mines) that cause lower extremity traumatic amputation cause forces to move upward through the body, which may cause further bone disruption, hollow organ collapse, or internal bleeding. Thus, first responders should use the Combat Ready Clamp (CRoC), the Junctional Emergency Treatment Tool (JETT), or the SAM Junctional Tourniquet to control junctional hemorrhage and stabilize the pelvis. In cases of penetrative eye trauma, responders should first perform a rapid field test of visual acuity, then tape a rigid shield over the eye to prevent further damage, and also give 400mg oral moxifloxacin as soon as possible. Pressure must never by applied to an eye suspected of penetrative injury.

Evaluating effectiveness
In order to evaluate the effectiveness of Tactical Combat Casualty Care, a study was conducted which analyzed US military casualties who died from an injury that occurred while they were deployed to Afghanistan or Iraq from October 2001 to June 2011. Of the 4,596 casualties, 87% died in the pre-medical treatment facility, prior to receiving surgical care. Of the casualties in the pre-medical treatment facility, 75.7% of the prehospital deaths were non-survivable, while 24.3% of deaths were potentially survivable. Instantaneous non-survivable mortalities included physical dismemberment, catastrophic brain injury, and destructive cardiovascular injury. Non-instantaneous non-survivable mortalities included severe traumatic brain injury, thoracic vascular injury, high spinal cord injury, and destructive abdominal pelvic injury. These injuries are very difficult to treat given currently fielded medical therapies such as Tactical Combat Casualty Care.

In terms of potentially survivable mortalities, 8.0% of mortalities were associated with airway obstruction. Majority of mortalities (90.9%) which were classified as potentially survivable mortalities were attributed to hemorrhage, with 67.3% of the hemorrhage being truncal, 19.2% junctional, and 13.5% extremity. During the study period, there were no effective protocols put in place to control junctional or truncal sources of hemorrhage in the battlefield, which suggests a gap in medical treatment capability.

This study shows the majority of battlefield casualties which occur prior to receiving surgical care are non-survivable. However, of the casualties which are survivable, the majority of deaths can be attributed to hemorrhages. Developing protocol which can control and temporize hemorrhage in the battlefield would improve the effectiveness of Tactical Combat Casualty Care, and decreases the number of casualties in the battlefield.

Another study analyzed the effectiveness of tourniquets for hemorrhage control, which are used in Tactical Combat Casualty Care. A four-year retrospective analysis showed that out of 91 soldiers who were treated with tourniquets, 78% of tourniquets were applied effectively. The success rate for tourniquets applied to upper limbs was 94% while the success rate for tourniquets applied to lower limbs was 71%. The difference between the success rates can be attributed to the tourniquets themselves, as in another study, tourniquets applied on healthy volunteers resulted in a much lower success rate for lower limbs in comparison to upper limbs. Therefore, the tourniquets themselves can be redesigned to increase its effectiveness and improve Tactical Combat Casualty Care.

A prospective study of all trauma patients treated at the Canadian-led Role 3 multinational medical unit (Role 3 MMU) established at Kandahar Airfield Base between February 7, 2006, to May 20, 2006, was conducted to examine how Tactical Combat Casualty Care interventions are delivered. The study concluded that tourniquets are effective, but must be used appropriately. The distinction between venous and arterial tourniquets must be reinforced in Tactical Combat Casualty Care training. Tactical Combat Casualty Care courses must also train soldiers to remove tourniquets for the purposes of reassessing trauma after the patient and caregiver is no longer under enemy fire. This is because the risks of iatrogenic ischemic injury of prolonged use of tourniquets outweigh the risks of increased blood loss.

The study also identified technical errors in performing needle decompressions. All needle decompressions were performed at least 2 cm medial to the mid-clavicular line and well within the cardiac box. This may result in injury to the heart and surrounding vasculature. Tactical Combat Casualty Care training must reinforce using landmarks when performing needle decompressions. This is especially useful since soldiers may have to perform this procedure in poor lighting conditions.

title: Battlefield medicine


text:
Talk:Hicks (disambiguation)

This really should be a disambiguation page. RickK 23:35, 27 Nov 2003 (UTC)

It's an orphan but it probably should be a dismabiguation for all Hicks. Secretlondon 23:37, Nov 27, 2003 (UTC)

title: Talk:Hicks (disambiguation)